A 63-year-old woman is 5 hours post live donor renal transplant and is complaining of abdominal pain. The nurse looking after the patient notices that the urinary catheter has not drained any urine in the last 90 minutes despite 1:1 replacement of fluids (1 mL of crystalloid infusion for every 1 mL of urine output during the previous hour). Obstruction of the catheter is ruled out.
Which of the following is the most likely cause?A. Postoperative hemorrhage
Correct Answer: C
Renal artery thrombosis is a devastating posttransplant complication that usually results in graft loss. Fortunately, it is an uncommon complication occurring in less than 1% of patients. Early identification and intervention is most important. It usually presents with sudden cessation of urine output and a tender, swollen graft. Risk factors include hypotension, hypercoagulable state, and multiple renal arteries. Diagnosis is usually made with color flow Doppler studies. Once the diagnosis is made, urgent surgical exploration and thrombectomy is indicated. Outcomes are unfavorable as the transplanted kidney does not have collateral vessels, and its tolerance of warm ischemia is poor.