Renal artery intimal injury during kidney transplant is infrequent but potentially devastating, especially when situated near the hilar trifurcation, where standard reconstruction techniques are frequently unfeasible. Prompt identification is difficult because the arterial pulse may persist despite significant luminal obstruction. We report a case involving a 24-year-old female living donor whose left kidney was transplanted into a 54-year-old male recipient with end-stage renal disease. Although initial reperfusion appeared satisfactory, the graft gradually became cyanotic and soft during the procedure. Doppler signals remained preserved, and there was no response to vasodilatory interventions. We suspected arterial inflow impairment, and so we proceeded with inspection of the vascular anastomoses and revealed intimal disruption with significant luminal narrowing at the hilar trifurcation. Given the lack of a reconstructible distal arterial segment, patch angioplasty was performed using an expanded polytetrafluoroethylene graft, thereby forming a composite arterial conduit while preserving the posterior native wall. Following reimplantation, graft perfusion improved, showing satisfactory intraoperative Doppler findings. The graft produced immediate urine output, although the postoperative course was complicated by severe acute tubular necrosis due to prolonged warm ischemia time (87 minutes). At 6 weeks, the patient remained independent from dialysis with a serum creatinine of 300 μmol/L (estimated glomerular filtration rate 21 mL/min/1.73 m2). Doppler ultrasonography confirmed sustained graft patency without evidence of stenosis or thrombosis, and a renal allograft biopsy showed no rejection. Further functional recovery remains possible but uncertain. To our knowledge, this is among the first reports of polytetrafluoroethylene patch angioplasty for treatment of near-hilar intimal injury in a living donor transplant. Polytetrafluoroethylene patch angioplasty constitutes a viable salvage methodology for near-hilar renal artery intimal injury in living donor kidney transplant. Polytetrafluoroethylene patch angioplasty achieves graft patency and dialysis-independent survival, even in cases with extended duration of warm ischemia time that may delay functional recovery.

This case report presents a 3-year-old female patient with erythematous lesions in the mouth and lips. She initially showed symptoms such as abdominal pain, vomiting, pale stools, and dark urine. Imaging revealed a large hepatic mass, diagnosed as alveolar rhabdomyosarcoma via biopsy. Chemotherapy began while metastasis was under evaluation. After 3 cycles of chemotherapy, she underwent tumor resection and liver transplant, followed by continued chemotherapy. Oral lesions that shifted from yellow-white to purple-brown appeared during treatment and were preliminarily diagnosed as erythema multiforme. Adjuvant therapy was administered accordingly.

Renal artery aneurysm is a rare vascular condition that could remain silent or could lead to potential life -threatening consequences, especially when there are multiple lesions. Endovascular treatment and open in situ surgical reconstruction are often considered first -line options, although not always feasible or durable. We report the case of a successful kidney autotransplant in a 56 -year -old female patient who had bilateral multiple renal artery aneurysms with calcified walls and parietal thrombotic apposition. Given the history of hypertension and the risks related to aneurysm rupture, the patient underwent laparoscopic nephrectomy followed by ex situ repair and heterotopic graft reimplant. We also compared our approach with the literature to report on the current evidence and the recommended management for renal artery aneurysms.

Situs inversus totalis is a rare congenital anomaly in which the thoracic and abdominal viscera are arranged in mirror image. The use of liver grafts from deceased donors with situs inversus totalis is a challenge because of the profound anatomical and technical variations that complicate implantation. Approximately 11 such transplants have been reported worldwide. Here, we present a case of orthotopic liver transplant in a 66 -year -old man with hepatitis C -related cirrhosis and hepatocellular carcinoma in which the graft was from a 17 -year -old deceased donor with situs inversus totalis. The graft, which displayed mirror -image hilar anatomy, was implanted with a modified piggyback technique, orienting the donor right lobe anteriorly; direct duct -to -duct biliary reconstruction was performed. Graft function was preserved through most of the first postoperative year, after which the patient developed progressive cholestasis and diffuse biliary strictures. Allograft biopsies demonstrated ischemic changes of the bile ducts and parenchyma consistent with ischemic cholangiopathy in the absence of hepatic arterial thrombosis, without evidence of acute rejection but potential features of subtle chronic rejection. The patient was not a candidate for retransplant and died 14 months after transplant. This case illustrates a technically successful situs inversus totalis donor graft that was complicated by late, diffuse, and irreversible biliary obstruction.