Non-mycotic anastomotic pseudoaneurysm of renal allograft artery. Case Report

Vascular complications after kidney transplantation are uncommon, and in most cases they present in the early post-transplant period. Anastomotic pseudo-aneurysms usually involve the renal transplant artery anastomosis and in most cases are the consequence of a mycotic contamination during organ recovery or handling of the graft. We report the case of a 61 year-old woman, who presented, eight months after successful kidney transplantation from a deceased donor, with mild pain in the right iliac fossa. Graft sonography and computed tomography scan demonstrated a 33-mm pseudo-aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. The patient underwent an emergent surgical intervention with resection of the pseudo-aneurysm. Renal transplant artery was re-perfused with a by-pass with the internal iliac artery, while the common iliac artery was revascularized through an autologous vein by-pass between the proximal external iliac artery and the common femoral artery. Postoperative course was complicated by inguinal lymphorrea, with complete resolution on postoperative day 22. Histopathologic examination of the pseudo-aneurysm wall did not reveal any sign of mycotic infection. At 6-month follow-up, graft function was stable and graft sonography demonstrated the patency of iliac-femoral by-pass and a normal renal graft perfusion. In conclusion, pseudo-aneurysm of the renal transplant artery is a rare but potentially life-threatening complication of kidney transplantation, occurring even in the late post-transplant period. Surgical resection of the pseudo-aneurysm, although challenging, may be a valuable option for definitive treatment of the pseudo-aneurysm, while preserving the renal graft function.