Treatment of Renal Capsule Lesion in a Transplanted Kidney: A Case Report and Literature Review

Abstract

Expanded donor criteria have been established to reduce organ wastage, as various factors can lead the disposal of kidneys, such as anatomical abnormalities, traumatic injuries, and iatrogenic injuries during organ retrieval surgery. We report a case of kidney transplantation in which a capsular lesion was identified and repaired during organ preparation (back table) and review of the literature regarding transplant kidney injuries. A diabetic and hypertensive 52-year-old patient with chronic kidney disease undergoing dialysis therapy for 2 years was admitted for a deceased donor kidney transplant. The donor was a 35-year-old man with brain death secondary to traumatic brain injury in a car accident. During the kidney preparation on the back table, a capsular lesion was visualized on the upper pole of the right kidney. Continuous suture of the renal capsule was performed using a 3-0 CatGut suture to correct the defect and reconstruct the renal surface. After renal reperfusion, no active bleeding was observed from the sutured area. The patient had a good postoperative course with no complications. The main complications associated with capsular lesions and complete capsular denudation are bleeding and hematoma formation, as well as urinary and lymphatic extravasation through the exposed renal parenchyma. Treatment may involve direct cauterization using electrocautery or argon plasma, or the use of hemostatic agents. Successful repair of capsular lesions not only prevents complications such as bleeding during reperfusion and urinary fistulae but also plays a crucial role in expanding the pool of organs available for transplantation.

Keywords

• Kidney Transplantation
• Chronic Kidney Disease
• Organ Retrieval Surgery
• Degloving Injury