LIQUEFACTION OF RENAL ALLOGRAFT: AN UNPRECEDENTED COMPLICATION IN TRANSPLANTATION MEDICINE
By Salman Javed Arain, Adam Morrell, Leeds Teaching Hospitals NHS Trust, Leeds
Background:
Renal transplantation stands as the gold standard treatment for end-stage renal disease (ESRD), offering improved quality of life and increased survival compared to dialysis. However, despite its advantages, renal allograft failure can occur, necessitating careful management to mitigate associated complications. Instances of liquefaction of the transplanted kidney are exceedingly rare, posing unique challenges to clinicians in the management of graft failure. Existing literature highlights the complexities surrounding decisions regarding dialysis reinitiation, immunosuppression management, and the potential need for transplantectomy in patients with failed renal allografts.
Case Presentation:
A 52-year-old Caucasian female with a complex medical history, including stage 5 chronic kidney disease (CKD), non-ST-segment elevation myocardial infarction (NSTEMI), hypertrophic cardiomyopathy with mild left ventricular systolic dysfunction (LVSD), atrial fibrillation (AF), and a history of cardiac arrest resulting in hypoxic brain injury, presented with a unique complication following renal transplantation. Imaging studies revealed complete breakdown and liquefaction of the transplanted kidney in the right iliac fossa. Despite interventions such as ultrasound-guided aspiration and drainage, the patient's condition continued to deteriorate.
Conclusion:
This case highlights a rare occurrence of graft liquefaction following renal transplantation, emphasising the need for vigilance in monitoring transplant recipients for uncommon complications. The management of such cases requires a multidisciplinary approach, considering factors such as dialysis reinitiation timing, immunosuppression management, and the potential need for transplantectomy. Further research is warranted to elucidate the pathophysiology and optimal management strategies for unique complications such as graft liquefaction, underscoring the importance of individualised treatment approaches in complex clinical scenarios.