Early Doppler changes in a renal transplant patient secondary to abdominal compartment syndrome

Physiologic changes in renal transplant patients, such as transiently low central venous pressure, may be related to increased intra-abdominal pressure, from the volume of the transplanted kidney itself. Using intraoperative and postoperative Doppler ultrasound of the transplant renal vessels, we identified changes in flow dynamics following closure of the abdomen and reversal of the changes when the abdomen was reopened. This was attributed to abdominal compartment syndrome and a fasciotomy was created in the abdominal wall to accommodate the transplanted kidney. The findings in this case, in keeping with abdominal compartment syndrome, are not often considered in transplant recipients, but may explain some of the postsurgical physiology in some patients, particularly in the pediatric population.