Reconstruction of necrotic kidney graft pelvis with a vascularized small bowel patch

Complete necrosis of the pelvis in a transplanted kidney is a rare but particularly severe complication that generally requires removal of the graft. Here, the case of a patient is reported in whom complete necrosis of the ureter and the pelvis occurred a few days after transplantation, while kidney function was excellent. After resection of all necrotic tissue, reconstruction of the pelvis was performed with a vascularized small bowel patch fixed to the renal parenchyma at the border of the intrarenal pelvis. The native ureter was then anastomosed to this reconstructed pelvis. Although the patient suffered from recurrent urinary tract infections in the early postoperative phase, he is now well, with normal kidney graft function and unimpaired urine flow through the reconstructed urinary tract, 18 months after transplantation. This report demonstrates that successful surgical reconstruction after complete necrosis of the renal pelvis in a grafted kidney can be achieved, although the long-term outcome of this graft-saving technique remains to be seen.