Calyceal fistula: a problematic, but treatable, complication of renal transplantation

Calyceal fistula is a rare complication of renal transplantation that may lead to graft loss. This article reports a case of functional recuperation of a graft that seemed condemned to failure.

31 year old male patient, submitted to living donor renal transplant, in which was necessary to ligate a superior polar artery found during donor nephrectomy, due to its short length. This resulted in development of a calyceal fistula, unsolved with conservative treatment by percutaneous drainage. A new surgical intervention revealed a large upper pole area of necrotic tissue, corresponding to the obliterated artery irrigation zone.

Debridement and calyceal suture were performed and a posterior pyelography confirmed fistula closure. Presently, he is asymptomatic, with stabilized graft function.

Calyceal fistulas are complications of difficult resolution. However, the present case demonstrates that with an appropriate treatment it is possible to save a graft with no apparent solution at the first place.