Renal allograft compartment syndrome

Renal allograft compartment syndrome is an uncommon and potentially underdiagnosed condition of early renal transplant dysfunction. It occurs mostly in transplants placed in the extraperitoneal space.

Pathology

The most common placement for a renal transplant has been in the extraperitoneal/retroperitoneal space, confined by anteriorly by the peritoneum, posteriorly and laterally by pelvic muscles. Occasionally, increased pressure in this relatively tight space may lead to compression of the transplant and if there is sufficient pressure this might lead to ischemia of the transplant. It seems more common with large allografts and some surgical techniques.

Peritransplant fluid collections may also cause extrinsic pressure on the allograft.

Radiolographic features

Ultrasound

• postoperatively (usually within 2 hours after transplantation) the extrinsic compression will cause markedly diminished (or absent) color/Power Doppler flow in the renal allograft cortex