Vascular anomalies among living kidney donors are seldom encountered and their presence offers a complex opportunity for every transplant surgeon. Furthermore, there has been an increasing trend with the use of marginal or kidneys with pathology to address the shortage of organs. We report a rare case of a kidney allograft with a saccular aneurysm and renal cortical cysts for which an excision with primary repair and partial nephrectomy were done, respectively. The recipient was a 45-year-old female with lupus nephritis and significant comorbidities who had excellent recovery and outcome. With good surgical techniques, these types of grafts continue to provide acceptable outcome but safety of the donor should be of utmost importance.
Renal artery aneurysms are rare occurrences whose incidence ranges from 0.1 to 1%, of which 80% is saccular in form [
A 45-year-old Caucasian female with end-stage renal disease secondary to lupus nephritis underwent a living donor kidney transplant with her husband (1-DR match) as her donor. Significant past medical history included a colon resection for perforation secondary to a peritoneal dialysis catheter complicated by an intra-abdominal abscess, preeclampsia, debridement, and skin grafting on the lower extremities for extensive fungal infection, hypertension, glaucoma, and a previous highly sensitized state due to multiple pregnancies and blood transfusions for which she underwent desensitization. A preoperative CT scan of the right kidney allograft showed an upper pole cyst measuring
Saccular aneurysm of the donor renal artery before (a) and after (b) vascular reconstruction (
We then proceeded with a partial nephrectomy for the 2 renal cortical cysts (Figure
Renal cortical cysts located in the upper pole (a) and lower pole (b) of allograft.
The use of marginal kidneys and grafts with anatomical abnormalities has been increasingly reported due to the lack of organs [
A CT angiogram has become the standard method of evaluating potential living kidney donors with reported sensitivity and specificity for arterial anatomy of 91 and 93%, respectively [
CT angiogram with 3D reconstruction shows a saccular aneurysm arising from the proximal right lower pole renal artery at the bifurcation of the main renal artery (
Olakkengil and Mohan Rao reported a series of 6 donors, both living and deceased, with renal artery aneurysms mostly performing an excision and primary closure with favorable outcomes, although 1 recipient had graft loss after a year which was unrelated to the vascular reconstruction [
To our knowledge, this is the first such case to be reported in the literature. Based on its size, the aneurysm was amenable for excision and primary repair
In conclusion, surgically correctable abnormalities on renal allografts, either as a single pathology or, such as this case, in combination, are able to provide excellent outcomes once they are repaired. However, while the use of these grafts are safe, careful donor screening cannot be over emphasized to ensure that the remaining kidney is normal.
The authors declare that they have no conflict of interests.