The case study concerns an adult patient who underwent a pre-transplant nephrectomy to prepare for a kidney transplant. After being discharged from the hospital, the patient was readmitted to the emergency room for severe pain and hematuria (blood in the urine). The patient was diagnosed with septic shock, including a high fever and hypotension.
Although the patient was discharged, distressing symptoms persisted. An additional imaging examination revealed that part of the kidney had been retained during the initial nephrectomy. As a result of this medical error, additional procedures and complex medical care were required, including the discontinuation of immunosuppressants and the initiation of dialysis.
An expert in kidney transplant surgery who performs pre-transplant nephrectomy procedures is sought for an opinion on standard care practices.
Questions to the Transplant Surgery expert and their responses
How often do you perform pre-transplant nephrectomy procedures and manage postoperative care?
I'm a clinical transplant surgeon with over 20 years of experience and the current chief of Solid Organ Transplants (SOT) at a campus that performs kidney, pancreas, liver, heart, and lung transplants. Pre-transplant nephrectomy procedures and postoperative care management are integral parts of my regular practice.
What are the most pertinent measures that a provider can perform to minimize the incidence of retained kidney during a pre-transplant nephrectomy procedure?
To minimize the risk of retaining kidney tissue during a pre-transplant nephrectomy procedure, it is crucial to ensure complete subcapsular removal. If a patient presents or re-presents with symptoms such as fever and hematuria, there should be a high index of suspicion for potential complications. Preventive measures also include a thorough examination of the specimen upon extraction and an intraoperative examination of the nephrectomy bed.
How does timeliness of diagnosis and intervention typically affect patient outcomes in cases of retained kidneys post-pre transplant nephrectomy?
The timing of diagnosis and intervention is critical in cases of retained kidneys post-pre transplant nephrectomy. Immediate investigation into potential complications should be initiated when symptoms like those described here are present, as it can significantly impact patient outcomes.
Have you reviewed a similar case? If so, please briefly describe.
I have indeed reviewed a very similar case involving a retained remnant following transplant nephrectomy. It’s perhaps more common than appreciated.
About the expert
This expert is a seasoned transplant surgeon with over two decades of experience in general and transplant surgery. They are board-certified in general surgery, have contributed to numerous clinical trials, and have published extensively on the subject, including over 60 journal articles and four book chapters. Currently, they hold leadership positions as the division chief of transplant surgery and director of kidney and pancreas transplantation at a hospital in Wisconsin, further demonstrating their expertise in this field.