1. SALVAGE SURGERY FOR ALLOGRAFT RUPTURE Dr. SUNIL SHROFF Department of Urology & Renal Transplantation Sri Ramachandra Medical College & Research Institute (Deemed University) Chennai, India

2. ALLOGRAFT RUPTURE

3. Allograft Rupture 150 Renal Transplants 118 Live Related & 32 Cadavers 4 Allo-graft Ruptures 1 Cadaver & 3 Live Related

4. Cause of Allo-Graft Rupture Vascular Rejection - 2 ATN – 1 Venous Thrombosis - 1

5. Salvage Surgery In Three of the Graft Ruptures Salvage Surgery Attempted

6. Salvage Surgery In 2/3 Salvage Surgery Successful ( Vascular Rejection x 1 and ATN x 1) In one patient with Venous Thrombosis salvage unsuccessful

7. Salvage Surgery for Allograft Rupture Difficult No Preset Surgical Techniques Nothing much Available in surgical literature

8. 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

9. 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

10. 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

11. Greater Omental Wrap Proline sutures away from site of Rupture Surgical Technique For Salvaging Allo-Graft Rupture

12. 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.