Hany M. EL HENNAWY, Mostafa MARZOUK, Tariq JABER, Abdullah M. ALHARTHI, Ghaleb Abo ALSAMEH, Turki A. BANAMAH, Majed M. ALHARTHI, Nashat AL OTIBI, Omar SAFAR, Fadil HASSAN
Experimental and Clinical Transplantation - 2026;24(9):748-754
Objectives: Renal artery intima l injury during kidney transplant is infrequent but potentially devastating, especially when situated near the hilar trifurcation, where standard reconstruction techniques are frequently unfeasible. Prompt identification is difficult because the arterial pulse may persist despite significant luminal obstruction. We report a case involving a 24-year-old female living donor whose left kidney was transplanted into a 54-year-old male recipient with end-stage renal disease. Although initial reperfusion appeared satisfactory, the graft gradually became cyanotic and soft during the procedure. Doppler signals remained preserved, and there was no response to vasodilatory interventions. We suspected arterial inflow impairment, and so we proceeded with inspection of the vascular anastomoses and revealed intimal disruption with significant luminal narrowing at the hilar trifurcation. Given the lack of a reconstructible distal arterial segment, patch angioplasty was performed using an expanded polytetrafluoroethylene graft, thereby forming a composite arterial conduit while preserving the posterior native wall. Following reimplantation, graft perfusion improved, showing satisfactory intraoperative Doppler findings. The graft produced immediate urine output, although the postoperative course was complicated by severe acute tubular necrosis due to prolonged warm ischemia time (87 minutes). At 6 weeks, the patient remained independent from dialysis with a serum creatinine of 300 mumol/L (estimated glomerular filtration rate 21 mL/min/1.73 m 2). Doppler ultrasonography confirmed sustained graft patency without evidence of stenosis or thrombosis, and a renal allograft biopsy showed no rejection. Further functional recovery remains possible but uncertain. To our knowledge, this is among the first reports of polytetrafluoroethylene patch angioplasty for treatment of near-hilar intimal injury in a living donor transplant. Polytetrafluoroethylene patch angioplasty constitutes a viable salvage methodology for near-hilar renal artery intimal injury in living donor kidney transplant. Polytetrafluoroethylene patch angioplasty achieves graft patency and dialysis-independent survival, even in cases with extended duration of warm ischemia time that m ay delay functional recovery.
