SALVAGE SURGERY FOR ALLOGRAFT RUPTURE Dr SUNIL SHROFF

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 Ø 118 Live Related & 32 Cadavers 4 Allo-graft Ruptures Ø 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 Surgical Technique For Salvaging Allo-Graft Rupture On Convex Surface of Kidney

Proline sutures away from site of Rupture Greater Omental Wrap 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.