RENAL-ALLOGRAFT TORSION ASSOCIATED WITH PRUNE-BELLY SYNDROME

We report a 26-month-old child diagnosed with prune-belly syndrome and end-stage renal disease who received intraperitoneal implantation of an adult cadaveric renal graft which functioned very well for approxim ately 6 weeks. The patient then presented with acute renal failure whi ch was proved to be secondary to torsion of the graft, twisting the ar tery and vein. The ureter was wrapped 360 degrees around the graft, Th ese conditions resulted in loss of the graft and nephrectomy. Ours is the second report of such an occurrence; the first was from a living-r elated kidney donor. We believe the lack of abdominal wall tone contri butes to graft mobility and risk of torsion of the kidney. We recommen d that nephropexy be considered in these patients. In addition, the ri sk of torsion must be at the forefront of the differential diagnosis i n a prune-belly renal transplant patient with acute onset of oliguria. Renal sonography with Doppler should be employed as soon as possible so that the graft can be saved.