Nephrorrhagy from a transplanted kidney

A single kidney was harvested from a cadaveric donor who had sustained cranio-cerebral injury and blunt abdominal trauma. The controlateral kidney was discarded because of direct injury. Following 11 hours of cold ischemia, the allograft was transplanted into a 13 yr old recipient without complications. Increased vesical hemorrhage was noted immediately postoperatively and on the 3rd and 5rd post transplant days, blood transfusions were necessary. Angiography, cystoscopy and groin exploration all failed to elucidate the cause of the nephrorrhagy. Graftectomy was eventually performed on the 9th post transplant day and on sagittal section of the kidney, a veno-calyceal fistula was discovered. The conventional diagnostic methods are only capable of revealing gross pathology of the allograft and in the absence of cortical fractures, the visual assessment and perfusion characteristics of the kidney are not sufficiently reliable. Particular attention should be paid to kidneys removed from donors who have sustained even localized abdominal injuries and, in all probability, kidneys originating from such donors should be discarded.