Kidney Allograft Torsion After Simultaneous Pancreas Kidney Transplantation: Case Report and Review of Literature.

Kidney allograft torsion (KAT) is a rare but critical complication of kidney transplantation that can lead to graft loss due to acute ischemia. This report presents a case of KAT resulting in graft loss 9 months following intraperitoneal simultaneous pancreas and kidney (SPK) transplant and reviews previous reports to identify potential high-risk features. A 38-year-old female with end-stage renal disease secondary to Type 1 diabetes mellitus underwent an intraperitoneal enteric drained SPK transplant. Nine months post-transplantation, she presented with nausea, vomiting, severe abdominal pain, decreased urine output, and diarrhea. An ultrasound showed moderate hydronephrosis and no blood flow to the renal hilum. Exploratory laparotomy revealed a necrotic renal allograft twisted 360° counterclockwise on its vascular pedicles. Despite detorsion, the graft showed no signs of viability, necessitating transplant nephrectomy. This case highlights the rarity and severity of KAT, particularly in intraperitoneal kidney transplants. The patient's low body mass index (BMI) (23.4 kg/m²), female sex (wider pelvis), and minimal intra-abdominal adhesions may have contributed to increased graft mobility, predisposing to KAT. Other potential risk factors include elongated vascular pedicle and immunosuppression-related reduced adhesion formation. The nonspecific presentation of KAT emphasizes the need for high clinical suspicion and prompt ultrasonographic evaluation in cases of graft abnormalities. This report underscores the importance of considering patient- and graft-specific factors in assessing KAT risk and the critical nature of early detection and intervention to prevent graft loss.