SALVAGE SURGERY FOR ALLOGRAFT RUPTURE Dr. SUNIL SHROFF Department of Urology & Renal Transplantation Sri Ramachandra Medical College & Research Institute.

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SALVAGE SURGERY FOR ALLOGRAFT RUPTURE Dr. SUNIL SHROFF Department of Urology & Renal Transplantation Sri 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 Technique 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.