Bilateral Psoas Haematomata Complicating Renal Transplantation

Background. The challenge in managing patients undergoing renal transplantation is how to achieve optimum levels of anticoagulation to avoid both clotting and postoperative bleeding. We report a rare case of severe postoperative retroperitoneal bleeding including psoas haematomata complicating renal transplantation. Case Report. SM, a 55-year-old female, had a past history of aortic valve replacement, cerebrovascular event, and thoracic aortic aneurysm and was on long-term warfarin that was switched to enoxaparin 60？mg daily a week prior to her living donor transplantation. Postoperatively, she was started on a heparin infusion, but this was complicated by a large retroperitoneal bleed requiring surgical evacuation on the first postoperative day. Four weeks later, she developed features compatible with acute femoral neuropathy and a CT scan revealed bilateral psoas haematomata. Following conservative management, she made steady progress and was discharged home via a community hospital 94 days after transplantation. At her last visit 18 months after transplantation, she had returned to full fitness with excellent transplant function. Conclusion. Patients in established renal failure who require significant anticoagulation are at increased risk of bleeding that may involve prolonged hospitalisation and more protracted recovery and patients should be carefully counselled about this. 1. Introduction Measures to prevent venous thromboembolism (VTE) are well established in the management protocol of patients undergoing major surgery. Although decreased thrombogenicity is common in patients with established renal failure, VTE prophylaxis is important in preventing thrombosis of the vascular supply of a new allograft and potentially preventing graft loss. This is particularly necessary in patients with prothrombotic conditions such as a history of VTE, coagulopathy, arrhythmias, or metallic heart valves. The challenge is to use the optimum level of anticoagulation to avoid both clotting and postoperative bleeding. We report a rare case of severe postoperative retroperitoneal bleeding including psoas haematomata complicating renal transplantation. 2. Case Report SM, a 55-year-old female, in established renal failure secondary to adult polycystic kidney disease, received a living unrelated renal transplant through an exchange donor program. The kidney was implanted in the left iliac fossa. Her past medical history included a mechanical aortic valve replacement, cerebrovascular accident, and ascending thoracic aortic aneurysm treated by aortic root replacement and