Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2017; 7(1): 88-93
Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.88
Allograft loss from acute Page kidney secondary to trauma after kidney transplantation
Kazuhiro Takahashi, Rohini Prashar, Krishna G Putchakayala, William J Kane, Jason E Denny, Dean Y Kim, Lauren E Malinzak
Kazuhiro Takahashi, Krishna G Putchakayala, William J Kane, Jason E Denny, Dean Y Kim, Lauren E Malinzak, Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI 48202, United States
Rohini Prashar, Nephrology and Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
Author contributions: Takahashi K, Prashar R and Malinzak LE designed the report; Takahashi K, Putchakayala KG and Kane WJ collected the data; Takahashi K and Malinzak LE wrote the paper; Denny JE and Kim DY performed critical revisions of the paper.
Institutional review board statement: The case report was exempt from the Institutional Review Board standards at Henry Ford Hospital in Detroit.
Informed consent statement: The patient involved in this study gave written consent, authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: None of the authors has conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lauren E Malinzak, MD, Transplant and Hepatobiliary Surgery, Henry Ford Hospital, 2790 West Grand Boulevard, Detroit, MI 48202, United States. lmalinz1@hfhs.org
Telephone: +1-313-9162941 Fax: +1-313-9164353
Received: October 30, 2016
Peer-review started: November 3, 2016
First decision: December 1, 2016
Revised: December 19, 2016
Accepted: January 11, 2017
Article in press: January 12, 2017
Published online: February 24, 2017
Processing time: 114 Days and 3.4 Hours
Abstract

We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria. His serum creatinine level was slightly elevated from his baseline. Computer tomography revealed a large subscapular hematoma around the transplant kidney. The patient was observed to have renal trauma grade II at the hospital over a period of three days, and he was finally transferred to a transplant center after his urine output significantly decreased. Doppler ultrasound demonstrated an extensive peri-allograft hypoechoic area and abnormal waveforms with absent arterial diastolic flow and a patent renal vein. Despite surgical decompression, the allograft failed to respond appropriately due to the delay in surgical intervention. This is the third reported case of allograft loss from acute Page kidney following kidney transplantation. This case reinforces that kidney care differs if the kidney is solitary or a transplant. Early recognition and aggressive treatments are mandatory, especially in a case with Doppler signs that are suggestive of compression.

Keywords: Page kidney, Kidney transplantation, Trauma, Subcapsular hematoma, Doppler ultrasound

Core tip: We experienced a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. This case reinforces that care for a transplanted kidney differs from care of a native kidney. Early recognition and aggressive treatments are mandatory, especially when Doppler signs suggest there is compression of the transplanted kidney. To the best of our knowledge, our case is the third case of allograft loss from Page kidney following kidney transplantation.