Supplementary Material for: Rare complication of Renal Torsion in Autosomal Dominant Polycystic Kidney Disease following an Intraperitoneal Kidney Transplantation

Autosomal dominant polycystic kidney disease (ADPKD) presents in individuals with chronic renal disease due to bilateral renal cysts. This case describes the progression of the disease with the rare complication of renal torsion of the transplanted kidney in a patient with ADPKD. To our knowledge, this clinical incidence of renal torsion post-transplant has only been reported in 40 cases in the literature, of which only 3 cases involved ADPKD with two intraperitoneal and one retroperitoneal kidney allograft. The allografts in these 3 cases were salvaged by performing a nephropexy, while our novel case of intraperitoneal renal torsion in ADPKD resulted in loss of allograft viability. A 51-year-old female patient received a living, unrelated donor kidney transplant for end stage renal disease (ESRD) secondary to ADPKD. She underwent a bilateral native nephrectomy three years later. Five years post-transplant, the patient presented to the hospital with significant right lower quadrant abdominal discomfort, oliguria, and nausea. Following admission to the transplant service, she underwent an exploratory laparotomy which revealed a 180-degree counterclockwise torsion of the transplanted intraperitoneal kidney. Renal detorsion was attempted, however extensive renal infarction occurred, resulting in poor transplant viability. Currently, the patient is undergoing hemodialysis 3 times a week with a plan for re-transplantation when stable. The patient is continuing her immunosuppression regimen and prophylaxis in preparation for a future transplantation. Due to the rare incidence of renal torsion post transplantation in ADPKD, this study emphasizes the importance of post-surgical imaging and recognizing the symptoms of torsion to avoid loss of allograft viability. Promoting ongoing physician and patient education regarding surgical technique, symptom progression, and imaging protocols post transplantation is recommended, especially in complex genetic conditions such as ADPKD.