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Background/Aims: Delayed graft function (DGF) is associated with adverse outcomes after renal transplantation. Bone morphogenetic protein-2 (BMP-2) is involved in both endothelial function and immunological events. We compared expression of BMP-2 in epigastric artery of renal transplant recipients with immediate graft function (IGF) and DGF. Methods: 79 patients were included in this prospective study. Patients were divided in IGF group (64 patients) and DGF group (15 patients). BMP-2 expression in intima media (BMP2m) and endothelium (BMP2e) of epigastric artery was assessed by immunohistochemistry. Results: Lower intensity of BMP2e staining was recorded in DGF compared to IGF. In DGF patients, 93% had no expression of BMP2e and 7% had 1st grade expression, compared to 45% and 41% in IGF group, respectively (P=0.001) (Pst grade expression). Patients who had BMP2e staining positive had lower odds for DGF (OR 0.059 [0.007, 0.477]) and this remained significant even after adjustment for donor and recipient variables, cold ischemia time, and immunological matching (OR 0.038 [0.003, 0.492]). Conclusions: Our results demonstrate that BMP-2 expression in endothelial cells of epigastric arteries may predict development of DGF.

Renal biopsy is often needed to diagnose posttransplant graft dysfunction. Although it is very safe due to availability of real-time imaging, complications do occur. We report a rare case of anterior abdominal wall vessel injury during allograft biopsy resulting in a large perigraft hematoma. It mimics a subcapsular hematoma due to intrarenal vessel injury leading to diagnostic confusion. We detected a partially thrombosed pseudoaneurysm 3 weeks after the biopsy which had feeders from superior and inferior epigastric artery confirmed by injecting contrast into the pseudoaneurysm. The pseudoaneurysm is due to injury to small branch of these arteries. We used a novel and a cost-effective therapeutic intervention to treat this pseudoaneurysm. We injected thrombin percutaneously into pseudoaneurysm which enables thrombosis of the feeder vessels preventing recurrence.

Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain that can lead to life-threatening bleeding, particularly in elderly patients receiving anticoagulation therapy. Type III RSHs, based on computer tomography (CT) evaluation, is characterized by active bleeding with intramuscular or intraperitoneal extension and hemodynamic instability. Medical contemporary knowledge of this condition is contentious and overall 20% of acute mortality has been reported. The purpose of this study was to retrospectively review our experience and outcomes in the management of RSHs treated with percutaneous arterial embolization of the epigastric vessels. We retrospectively analyzed 43 patients with RSH type III, submitted to percutaneous epigastric artery embolization from 2007 to 2015. Percutaneous arterial embolization was feasible and successful in patients with a high burden of comorbidities and receiving anticoagulation therapy. There was no acute mortality and a late mortality at 3 months of 9.1% (4/43) was not directly related to RSHs or arterial embolization. Patients with late mortality had lower ejection fraction, prolonged PTT, greater RDW and warfarin in overlapping with low-molecular-weight heparins. Transcatheter arterial embolization of the epigastric vessels was safe, feasible and effective in stopping the bleeding. Despite anti-platelets/anti-coagulation therapy and a high burden of comorbidities, there was no acute mortality related to RSH.