A case of traumatic renal graft rupture with salvage of renal function

An 18-yr-old man received a kidney graft from a 60-yr-old female cadaver do nor on February 8, 1996. Postoperative course was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On April 30, 1999, he colli ded with a truck while riding a motor cycle. Macroscopic hematuria was obse rved and CT showed an extensive retroperitoneal hematoma. Because his anemi a and hypotension were becoming worse after transfusion of 9 units of blood , he was operated on as an emergency case. A large rupture reaching the pel vis and calyces was observed in the upper pole of the grafted kidney. There were also numerous shallow lacerations, but the major arteries and veins w ere not injured. The rupture was closed by suturing the renal parenchyma wi th the peritoneum, and the other shallow lacerations were closed by suturin g the renal capsule. The kidney could be salvaged without requiring hemodia lysis. The serum creatinine was maintained at 2.1 mg/dL during follow-up. A review of the literature showed that 6 cases of traumatic renal graft rup ture with salvage of the kidney have been reported. Our present case was th e seventh, and was the most severe graft rupture reported so far.