RENAL PEDICLE TORSION AFTER SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANTATION

Background: Simultaneous kidney-pancreas transplantation has become a recognized therapy for type I diabetes mellitus patients with diabetic nephropathy, neuropathy, and retinopathy, In the vast majority of the se procedures, both grafts are placed intraperitoneally, which reduces posttransplant morbidity. Recently, in some of our recipients, we not ed renal dysfunction related to complications of the renal pedicle. Ou r objectives In this study were to identify the cause of this renal dy sfunction and to prevent its occurrence in future recipients. Study De sign: We undertook a retrospective chart review of simultaneous kidney -pancreas recipients who experienced renal dysfunction related to rena l pedicle complications. Results: We found four recipients with renal dysfunction related to renal pedicle torsion, diagnosed by serial ultr asound scans and kidney graft biopsies. Early diagnosis allowed salvag e of three kidney grafts, but one was lost after late diagnosis. Concl usions: A high level of suspicion is needed to diagnose renal pedicle torsion. If simultaneous kidney pancreas recipients have recurrent ren al dysfunction, and rejection has been excluded, serial ultrasound sca ns with color flow Doppler examinations are needed. Once the diagnosis is made, a nephropexy to the anterior abdominal wall is indicated to prevent further torsion and save the kidney graft. We recommend prophy lactic nephropexy of left renal grafts if the renal pedicle is greater than or equal to 5 cm long and if there is a 2 cm or more discrepancy between the length of the artery and the vein. (J Am Coll Surg 1998; 187:80-87. (C) 1998 by the American College of Surgeons).