Aneurysmectomy with Partial Nephrectomy on a Living Donor Renal Allograft: A Case Report

Vascular anomalies among living kidney donors are seldom encountered and their presence offers a complex opportunity for every transplant surgeon. Furthermore, there has been an increasing trend with the use of marginal or kidneys with pathology to address the shortage of organs. We report a rare case of a kidney allograft with a saccular aneurysm and renal cortical cysts for which an excision with primary repair and partial nephrectomy were done, respectively. The recipient was a 45-year-old female with lupus nephritis and significant comorbidities who had excellent recovery and outcome. With good surgical techniques, these types of grafts continue to provide acceptable outcome but safety of the donor should be of utmost importance. 1. Introduction Renal artery aneurysms are rare occurrences whose incidence ranges from 0.1 to 1%, of which 80% is saccular in form [1]. There are only a few reports of this pathology in the transplant setting. Its management mainly involves excision with primary closure or use of a prosthetic or native vessel patch. Excellent short- and long-term graft outcomes have been documented with these surgical techniques [1–8]. We report a unique case of a saccular aneurysm found incidentally on a living kidney donor associated with renal cortical cysts, which, when approached surgically, could potentially compromise renal graft function after transplant. 2. Case Report A 45-year-old Caucasian female with end-stage renal disease secondary to lupus nephritis underwent a living donor kidney transplant with her husband (1-DR match) as her donor. Significant past medical history included a colon resection for perforation secondary to a peritoneal dialysis catheter complicated by an intra-abdominal abscess, preeclampsia, debridement, and skin grafting on the lower extremities for extensive fungal infection, hypertension, glaucoma, and a previous highly sensitized state due to multiple pregnancies and blood transfusions for which she underwent desensitization. A preoperative CT scan of the right kidney allograft showed an upper pole cyst measuring ？cm and an inferior pole cyst measuring ？cm. The donor subsequently underwent an uncomplicated right donor laparoscopic nephrectomy. While preparing the allograft on the back table, it was noted that there was a ？cm saccular aneurysm on the bifurcation of the renal artery. A simple excision and primary closure was performed on this after meticulous dissection (Figure 1). Figure 1: Saccular aneurysm of the donor renal artery before (a) and after (b) vascular reconstruction ( arrow). We then