Kidney Allograft Rupture Following Transplantation: A Scoping Review
Hannah Moraa Bosire, Mogamat-Yazied ChothiaBackground
Kidney transplantation is the preferred therapy for kidney failure; however, complications still occur, among which kidney allograft rupture (KAR) is rare but potentially life‐threatening. This scoping review aimed to map our current understanding of KAR, focusing on clinical presentation, causes of KAR, management strategies and patient and allograft outcomes.
Methods
The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews methodology. Eligible studies included case reports, case series and observational studies, including retrospective consecutive series, reporting case‐level or aggregate data on KAR in adults. We searched Medline (PubMed), Scopus and Web of Science Core Collection from database inception to 5 March 2025 and re‐ran all three searches without a study‐design filter between 13 August and 4 September 2026.
Results
A total of 86 articles were included. One hundred and two cases of KAR were analysed at the individual‐patient level, and 34 consecutive series or cohort studies, comprising 367 ruptures among 20 202 transplants, contributed aggregate data; 36 of the 102 individually reported cases were drawn from six of these series and are therefore common to both strands. The mean recipient age was 35 years, and 65% were male. Chronic glomerulonephritis (33%) and hypertension (18%) were the leading reported causes of kidney failure. Acute allograft rejection was the most common precipitating factor for rupture (58%), followed by renal vein thrombosis (14%) and acute tubular necrosis (13%). Clinical presentation was dominated by graft pain or tenderness (88%), a fall in haemoglobin (62%) and hypotension (57%). The allograft was preserved in 49 of 102 cases (48%) and 53 (52%) underwent nephrectomy. Across the 33 single‐centre consecutive series, the pooled incidence of KAR was 1.84% (366/19 922; range between series 0.25%–10.75%), falling from 4.7% in series published before 1990 to 1.5% in those published from 1990 onwards, and 55% of ruptured grafts were preserved. Patient survival was 94%.
Conclusion
KAR is a rare complication of kidney transplantation, occurring in approximately 2% of transplants in consecutive series and most often precipitated by acute allograft rejection. Its reported incidence has fallen roughly threefold since 1990. Just under half of ruptured allografts were preserved and half required nephrectomy. Graft preservation was reported in 62% of the standalone case reports that made up the original version of this review but in only 39% of cases described within consecutive series, indicating that the case‐report literature materially overstates the likelihood of successful salvage. Patient survival was high.