Femoral nerve lesion subsequent to renal transplantation

Severe femoral neuropathy subsequent to renal transplantation is described in a patient who died in the 5th postoperative week. Postmortem examination revealed a compression of the femoral nerve by an older hematoma of the iliac muscle, ipsilateral to the transplantation, and severe Wallerian degeneration of the nerve beginning at the site of the hematoma. It is postulated that the hematoma resulted from surgical trauma on the iliac muscle and was facilitated by previous anticoagulation and hypertensive vasculopathy. We suggest that every patient with similar symptoms occurring after renal transplantation should be investigated for a retroperitoneal hematoma. If such a hematoma is diagnosed, immediate decompression neurolysis should be performed in order to prevent prolonged recovery time or permanent disability.