Salvage after Retroperitoneal Kidney Allograft Torsion

Table 1

Allograft torsion after retroperitoneal renal transplants.

Date	Authors	Patient	Transplant indication	Ischemic time	Ultrasound findings	Time to reintervention	Proposed mechanism	Post-op course
2009	Ozmen, et al. 2013	44 yo M	Sepsis and renal failure—received kidney from a living related donor	Not reported, living donor transplant	US showed rotation of renal hilum and Doppler with stenotic flow	POD 5	Malposition of graft kidney	Recovered well
2013	Winter et al.	48 yo M	Hypertension and diabetes mellitus—received a deceased donor’s kidney	8 hours and 46 minutes of cold ischemia time	US with absent main renal vein flow and reversed diastolic arterial flow	4 hours	Raised body habitus and/or error in surgical technique	Return of adequate UOP after 1 week, discharged at POD 30
2014	Sosin et al.	42 yo M	Glomerulonephritis—received DCDK	4 hours of cold ischemia time	US at 11 hours post-op: tardus parvus and decreased resistive index	11 hours	Large potential space in iliac fossa, lax abdominal wall	Oliguric, required dialysis, required antithymocyte therapy for acute rejection on POD6, recovered kidney function, and discharged POD8
2018	Present case	69 yo F	ADPKD—received DBDK	12 hours and 52 minutes of cold ischemia time	US immediately post-transplant and 18 hours post-transplant	30 hours	Pressure form native polycystic kidney	As described: ureteral stent migration, hematoma, DVT, urosepsis

Abbreviations: YO: year-old; M: male; F: female; ESRD: End-Stage Renal Disease; POD: postoperative day; DCDK: Donor after Cardiac Death Kidney; DBDK: Donor after Brain Death Kidney; UOP: urine output; DVT: deep vein thrombosis; US: ultrasound.