The importance of early intraoperative ultrasonography and the relationship between surgical technique and allograft function in patients with compartment syndrome following renal transplantation surgery

Background/aim: In rare cases, patients undergoing renal transplantation (RT) may develop renal allograft compartment syndrome (RACS) if the renal volume is larger than the retroperitoneal space prepared in the iliac fossa. In such cases, the optimal treatment is early decompression surgery. The primary aim of the present descriptive and comparative study is not to identify the optimal surgical technique, but rather to evaluate the role of early Doppler ultrasonography (DUSG) in the recognition of renal allograft compartment syndrome and to assess outcomes following timely decompressive interventions. Materials and methods: A total of 275 patients were examined retrospectively for the study, including 247 with muscle and fascia closure and 28 with skin-only closure. Results: Only 28 (10.18%) of the patients with RACS underwent permanent fasciotomy and skin-only closure. No statistically significant difference was observed in the mean urine output between the two groups on any postoperative day, assessed based on the renal artery resistive index and peak systolic velocity. Conclusion: RACS should be considered in patients with large-sized allografts and small parailiac retroperitoneal spaces to address the inherent anatomical restrictions. Although early diagnosis with DUSG is essential for evaluating graft dysfunction in these patients, early decompression surgery should be considered crucial for the preservation of graft function in those with suspected RACS.