Kidney Allograft Salvage by Autotransplantation for a Suspected Infectious Arterial Pseudoaneurysm in a Pediatric Recipient

Transplant renal artery pseudoaneurysm is a rare complication following kidney transplantation. Noninfected pseudoaneurysms are increasingly managed with endovascular intervention; however, infected pseudoaneurysms often require surgical resection or transplant nephrectomy for definitive management. We report the case of a 14‐year‐old female kidney transplant recipient with a neurogenic bladder who developed recurrent UTIs and bacteremia. The patient was diagnosed with a 3.0 × 2.8 cm renal artery pseudoaneurysm. After a course of antibiotics, she underwent resection of the pseudoaneurysm and an involved segment of the right external iliac artery, followed by kidney autotransplantation to a deceased donor iliac artery interposition graft. Final cultures were negative for bacterial or fungal growth. Six years later, the patient remains off dialysis with a serum creatinine of 2.08 mg/dL (eGFR 34 mL/min/1.73m ² ). A review of the literature suggests that, in carefully selected recipients, excision of renal transplant pseudoaneurysms with renal autotransplantation can allow for allograft salvage.