SALVAGE SURGERY FOR ALLOGRAFT RUPTURE

Dr. SUNIL SHROFF

Department of Urology & Renal TransplantationSri Ramachandra Medical College & Research Institute (Deemed University) Chennai, India

ALLOGRAFT RUPTURE

Allograft Rupture

150 Renal Transplants 118 Live Related & 32 Cadavers

4 Allo-graft Ruptures 1 Cadaver & 3 Live Related

Cause of Allo-Graft Rupture

Vascular Rejection - 2

ATN – 1

Venous Thrombosis - 1

Salvage Surgery

In Three of the Graft Ruptures

Salvage Surgery Attempted

Salvage Surgery

In 2/3 Salvage Surgery Successful

( Vascular Rejection x 1 and ATN x 1)

In one patient with Venous Thrombosis salvage unsuccessful

Salvage Surgery for Allograft Rupture

Difficult

No Preset Surgical Techniques

Nothing much Available in surgical literature

Salvage Surgery for Allograft Rupture

All our graft rupture involved convex surface of the kidney

The steps of the surgery include Meticulous Clearance of all Hematoma surrounding the graft followed by a Complex Repair

Technique of Salvage Surgery for Allograft Rupture

Continuous Prolene ( 6/0 or 5/0 ) sutures on Renal capsule distant to the site of rupture were used

Strips of Muscle , peritoneum and Surgicel interposed in between Prolene Sutures to cover area of rupture

In one case super glue – Nectacryl was used for a persistent spot bleeder

Muscle Strip or Gelfoam or Peritoneal strip covering the Ruptured Graft

Allo-Graft Rupture On Convex Surface of

Kidney

Surgical Technique

For Salvaging Allo-Graft Rupture

Greater Omental Wrap

Proline sutures away from site of

Rupture

Surgical Techniqu

e For Salvaging Allo-Graft

Rupture

CONCLUSION

The surgery of saving a ruptured graft can be a daunting experience and exercise

It should however be first attempted before sacrificing the graft.