Renal allograft torsion, is sirolimus a culprit– Case series and review of literature

Background

Torsion is defined as rotation of allograft around its renal pedicle. It is a rare complication with high rate of graft loss. The nonspecific presentation and inability to provide definitive diagnosis by imaging in cases of partial torsion may delay the diagnosis and treatment.

Methods

We present two patients who were diagnosed with kidney allograft torsion (KAT) and underwent surgical exploration with varying outcomes. We also included the review of literature on KAT, highlighting the clinical presentation, investigation modality, intervention, and outcome. We identified reports of KAT in PubMed and Cochrane from 1990 through January 2021.

Results

22 manuscripts with 30 intraperitoneal and 6 extraperitoneal cases of KAT were identified. Most common presenting symptom was oliguria/anuria (11 cases) and abdomen pain (11 cases). Acute kidney injury was reported in almost all cases. Diagnosis of KAT by imaging was diagnosed in 7 cases before exploration. Surgical exploration led to graft salvage in 25 (69.4%) of cases and immediate transplant nephrectomy was performed in 11 (30.5%) of cases. Recurrence was documented in 3 cases and none of them had recurrence after surgical intervention

Conclusion

Renal torsion presents with various non-specific symptoms that could often be misdiagnosed. Since early suspicion and diagnosis is critical to prompt therapy and better graft outcome, including KAT as a possible cause of allograft dysfunction of unclear etiology particularly in patients with intraperitoneally placed allograft and sirolimus use, will be crucial.