[Renal allograft rupture attributed to coughing while asleep: a case report]

Area of Science:

• Nephrology
• Transplantation Surgery
• Surgical Complications

Background:

• Renal allograft rupture (RAR) is a rare but severe complication following kidney transplantation.
• While acute rejection is the most common cause, other factors are emerging due to improved immunosuppression.
• Understanding diverse etiologies of RAR is crucial for patient management.

Observation:

• A 53-year-old male developed sudden swelling and pain at the incision site after a forceful cough, 12 days post-living-donor renal transplant.
• Imaging revealed a perinephric hematoma, and surgical exploration showed abdominal fascia laceration and a 4-cm kidney graft rupture.
• The rupture was attributed to sudden high intra-abdominal pressure from coughing, causing fascial tearing and subsequent graft damage.

Findings:

• The patient's renal allograft ruptured due to forceful coughing, leading to abdominal fascia laceration and perinephric hematoma.
• Surgical repair involved parenchymal suturing with a fibrin tissue adhesive and collagen fleece.
• The patient maintained stable renal function at 12 months post-repair, with serum creatinine at 1.3 mg/dl.

Implications:

• This case presents coughing as an unusual but significant cause of renal allograft rupture.
• It underscores the importance of considering mechanical stress and intra-abdominal pressure in post-transplant complications.
• Effective surgical repair and monitoring can lead to favorable long-term outcomes even after significant graft rupture.