Salvage of an iatrogenic partial allograft nephrectomy during caesarean section-a case report

Since transplanted kidney allografts are standardly placed in a heterotopic pelvic position, any surgical intervention in the pelvis carries the potential risk for allograft injury. A 41-year-old female G4P2 with history of prior kidney transplants presented for an elective cesarean sections (CS). During the CS, profound bleeding was encountered and was later realized to be from the transplanted kidney allograft. A complete transection of the upper pole with the injury extending to the hilar structures was noted. Careful intraoperative evaluation led to the decision favoring a salvage attempt of the remaining part of the allograft. The patient continues to enjoy sufficient allograft function 6 months after the incident. To conclude, although CS after kidney transplantation is considered safe, the risk of allograft injury remains possible with potentially catastrophic consequences. This case highlights the importance of rapid surgical expertise and appropriate preoperative evaluation, preparation and planning.