Salvage of Renal Allograft Rupture in a COVID-19-Positive Patient with Buttressing Rectus Sheath: An Innovative Approach

Abstract

Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. Mostly graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. The exact pathogenesis of RAR is still not clear. Acute cellular rejection causes inflammatory reaction that leads to interstitial edema. Capsule tension due to edema leads to tension and tearing and may lead to RAR. COVID-19 infection in patient on immunosuppression like post-renal transplant is a worrisome disease with high morbidity and mortality. This posttransplant patient developed fever and decreased urine output, for which biopsy was done. On exploration, the graft was found to be ruptured. Graft salvage was tried with argon beam laser, surgical glue, and pressure but failed. The renal graft was then salvaged using buttressing rectus sheath graft in this COVID-19 patient.