1Royal North Shore Hospital, St Leonards, Australia

Background:  We present the first case of renal graft compression from central adiposity resulting in acute kidney injury.
Case Report: A 61 year old man with a cadaveric transplant presented with hypertension and acute kidney injury with a creatinine rise from 80 to 210 µmol/L. His past medical history included controlled diabetes, hypertension, ischaemic heart disease, and obesity requiring gastric sleeve with subsequent weight gain from 90 to 110kg. Renal biopsy was consistent with acute tubular necrosis without significant interstitial inflammation or signs of rejection. Serial renovascular doppler studies of the transplant graft were abnormal. Initial scanning showed severely reduced diastolic flow normalising towards the upper pole (RI0.78). The renal vein flow had normal phasicity and renal artery velocity was 336cm/s. Repeat scanning showed absence of diastolic flow and reduced perfusion despite a patent renal transplant artery and vein. Raising the fatty apron cephalad normalised renal blood flow with resistive indices between 0.76-0.79 throughout the kidney. Subsequent laparascopy ruled out adhesional obstruction and CO2 angiogram confirmed normal transplant vessels, anastomotic sites and intra-renal branches. Following initial empiric pre-biopsy pulsed steroids for presumed rejection, he was treated with bedrest and his creatinine was130µmol/L on discharge. Whilst advising weight loss, he was treated with an abdominal support belt.
Conclusions: Transplant physicians and surgeons need to be aware of renal graft compression from an enlarged bulky omentum and fatty apron. Diagnosis requires positional prone doppler sonography. Aside from weight loss, optimal treatment is not known.

Prior to enrolling in medical school, Sebastian completed a Bachelor of Science in Medical Biochemistry to provide a scientific foundation to a future in academic clinical medicine. After graduating from medical school at King’s College London, he continued his post graduate training in Bristol University Hospital Trust and St George Hospital, Sydney, completing FRACP in 2016. He is currently undertaking advanced training in nephrology and collaborating at QIMR Berghofer Institute in cellular immunology. His main academic focus is renal transplantation and transplant immunology.


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