Suture-free polyglactin 910 mesh repair of kidney graft rupture: A case report and review of literature

Background: Transplantectomy has long been considered the preferred treatment for spontaneous renal graft rupture, prioritizing patient safety over kidney salvage. In the last decade, there has been an increasing number of reports showing that, in selected scenarios, conservative management through graft repair represents a feasible option, challenging traditional approaches. Case summary: We describe the case of a 37-year-old sensitized XY patient who experienced early spontaneous graft rupture after receiving his second deceased donor kidney transplant. Following temporary hemodynamic stabilization and abdominal contrast enhanced computed tomography scan assessment, the recipient was brought back to theatre for surgical exploration. Possible causes of irreversible graft damage were immediately ruled out. The fractured upper pole of the transplanted kidney was repaired using a fibrin sealant, external compression, and a tailored polyglactin 910 mesh wrapped around the graft. The post-operative course was uneventful. After 20 months of follow up, the patient is doing very well, with excellent renal function and complete reabsorption of the mesh, as demonstrated by serial ultrasound evaluations of the graft. Conclusion: Amid organ shortages and sensitized patients, graft nephrectomy is reserved for severe injuries; repair using sealants and mesh is effective.