#0074

Spontaneous graft rupture in a post RAR day 11 pt with acute graft rejection,managed with rectus sheath patch stiches followed by graft nephrectomy in 24 yrs male pt

D. Sadasukhi¹, D. Varanwal², D. Mittal³

¹MGH, Kidney transplant, Jaipur, India
²MGH, Urology, Jaipur, India
³MGH, Nephrology, Jaipur, India

Introduction:

A 24 yrs male patient underwent Renal allogenic transplant having a bld gp of O positive ,mother was donar with a blood group of O negative,with bilateral single renal artery n pt had IGA Nephropathy as a cause of bilateral RMD n CKD

Material and methods:

On post op Day 11 pt developed high grade fever of 104 degrees,TLC showed 17k,urine output put started decreasing from 450 to 150 ml per hr,n clinically pr had tense wound with echymosis n recipient USG showed large collection of 250 cc at upper pole n RI at upper pole was low,n Hb dropped frm 11.2 to 5.1 gm percent,so emergency re exploration was planned after arranging 4 prbc. On exploration revealed a 300 cc clotes n hematoma at upper pole of graft kidney n a capsular breach of 5 by 10 cms oval defect was present n continuous oozing of blood was present from it, so a hemopatch was applied for half n hr bt failed n rectus sheath patch stitches wer applied at 3 points near hilum wich finally stopped bleeding n wound was closed on a 28 no abdominal drain, it had a out put of 500 cc frst 12 hrs n 700 cc serious after 36 hrs so a plan for graft nephrectomy was made n after anasthetic workup graft nephrectomy was done n pt had to undergo dialysis a day after. Now pt is off immunosuppresants with a creatinine of 6.2 with antihypertensive n twice weekly dialysis with stable vitals n full oral diet.

Results:

After acute rejection in a 24 yrs male on post op Day 11 presented with spontaneous graft rupture managed with hemopatch,rectus sheath patch vicryl stitch through n through kidney finally managed with graft nephrectomy,pt on biweekly hemodialysis now.