Cost of a delay

Abandoning a renal transplant operation during a live-related transplant is a rare occurrence. We recently encountered a case of previously undiagnosed coarctation of aorta (CoA) in the recipient during surgery. This was diagnosed by the absence of femoral pulses, a Doppler scan showing monophasic flows bilaterally in the iliac arteries and a difference in the mean arterial pressure between the radial artery and iliac artery of 50 mm Hg. The donor and recipient surgery were abandoned. A CT aortogram was done on the recipient which showed a tight CoA. An angioplasty was performed and a bare metal stent placed for correction of CoA. After a week, transplantation was performed, and the patient made an uneventful recovery. This case highlights the importance of assessment of the peripheral pulses and noting a radiofemoral delay, which was missed in the preoperative assessment.