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One of the rare but catastrophic complications after renal transplant is aortic dissection and there have only been a few reports in the literature of acute aortic dissection in kidney transplant recipients. We present a patient who had an incidentally detected aortic dissection in the immediate post-operative period after a kidney transplant.
A 31-year-old gentleman who underwent the renal transplant had accelerated hypertension in the immediate post-operative period requiring IV anti-hypertensive. A routine ultrasound doppler of transplant kidney done on post-operative day 1 in view of decreased urine output incidentally revealed a suspected aortic dissection. The patient, however, was asymptomatic. CT aortogram done subsequently confirmed a Stanford Type B dissection of the thoracic aorta. He underwent thoracic stent grafting on 27/11/2020. The dissection caused sluggish flows through bilateral iliac vessels and through transplanted kidney. On post-transplant day-5, he developed transient episode of black-out. An MRI brain was done, which revealed acute lacunar infarct in areas of both anterior and posterior circulation along with vertebral artery V4 occlusion. A search for the source of the emboli was in vain. His urine output then improved and the serum creatinine improved to 0.93mg/dL at the time of discharge.
Aortic dissection occurring post-transplant is more commonly reported with cardiac transplant, with only a few cases being reported after kidney transplant recipient. However, renal transplantation recipients tend to have hypertension, weak vessels, and vascular calcification. The hypertension and atherosclerotic aorta could lead to aortic dissection after renal transplantation.