Compression neuropathy subsequent to renal transplantation

doi:10.1016/0090-4295(76)90300-9

Urology

Volume 7, Issue 2, February 1976, Pages 145-147

https://doi.org/10.1016/0090-4295(76)90300-9 Get rights and content

Abstract

Compression neuropathy occurred in 7 patients who underwent renal transplantation. The neuropathy occurred on the same side as the surgery and was associated with the use of self-retaining retractors. Other contributing factors were presence and degree of uremia and diabetes. We suggest that self-retaining retractors be used carefully and length of application reduced to a minimum. Efficient dialysis prior to transplantation may decrease the incidence and severity of neurologic deficit by reducing the extent of uremia.

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Cited by (29)

Characteristics of Femoral Motor Neuropathies Induced after Kidney Transplantation: A Case Series
2016, Transplantation Proceedings
Citation Excerpt :
Unfortunately, the middle femoral nerve in the pelvic cavity receives poor blood supply from the iliolumbar artery, which is a small branch of the internal iliac artery, and the deep circumflex iliac artery from the external iliac artery. These arteries form a watershed area, resulting in a middle femoral nerve that is vulnerable to ischemia [1,2,7]. In the field of obstetrics and gynecology, urology, and orthopedics, the mechanism and causative factors of femoral neuropathy are relatively well correlated.
Femoral motor neuropathy (FMN) induced after kidney transplantation (KT) can injure the patient and graft, and it sometimes can leave sequelae on gait. Nevertheless, the cause of FMN has not been determined. We assessed 5 cases of FMN in an attempt to determine the traits induced after KT.
Patient data about general characteristics, immunologic characteristics, operative findings, post-operative status, and FMN characteristics were assessed. A Bookwalter self-retaining retractor was used and quadruple immunosuppression was implemented in all cases.
Five patients had FMN. Four of the 5 patients were women. The mean body mass index (BMI) was 20.38 ± 1.99 kg/m² prior to KT and 19.08 ± 1.98 kg/m² after KT. The mean graft-recipient weight ratio was 3.46 ± 0.99 g/kg. There was no case of psoas muscle abscess or hematoma. Motor function recovery was obtained 3 to 313 days after rehabilitation. Immediate graft function was favorable in all patients with no rejection or significant complications.
FMN after KT may occur in patients with a lower BMI and higher graft-recipient weight ratio. This study was based on only 5 patients, and therefore further studies with a larger population size are necessary.
Acute femoral neuropathy: A rare complication after renal transplantation
2010, Transplantation Proceedings
Citation Excerpt :
According to the underlying pathophysiologic mechanisms, damage secondary to retracting devices leading to neuropraxy of the nerve is thought to recover faster than severe ischemic problems, which lead to axonal loss. Owing to real tissue loss, ischemic neuropathy tends to recover at a slower rate and mostly incompletely.9,10 Although it has been suggested that the left femoral nerve would be more prone to ischemia, followed by slower recovery,6,12 we did not observe this in our (small) series (Table 1).
Femoral neuropathy is a rare but disabling complication following renal transplantation and pelvic surgery in general. In a retrospective review, we analyzed the incidence, clinical presentation, and outcome of this complication after renal transplantation in our center. In addition, we conducted a literature search on this complication.
Five cases of isolated femoral neuropathy after renal transplantation were encountered at our center, out of 3,448 renal transplantations performed over a 47-year period.
All of these patients presented with a weakness of hip flexion (iliopsoas muscle) and knee extension (quadriceps muscle) starting immediately after surgery. Atrophy of the quadriceps became apparent in severe and prolonged cases. In addition, numbness and paresthesia located in the anteromedial part of the thigh were present in 3 patients.
Isolated neuropathy of the femoral nerve is a rare but disabling complication after renal transplantation. The etiology of isolated femoral neuropathy often results from direct compression of the femoral nerve or from indirect compression on the psoas muscle by application of self-retaining retractors placed during pelvic surgery. Other factors that can play a role in the pathogenesis are related to direct ischemia of the nerve by clamping of the iliac artery, thus interrupting the pelvic blood supply to the femoral nerve during the vascular anastomosis or vessel dissection, or by postoperative hematoma in the retroperitoneum or psoas muscle. Meticulous surgery and careful positioning of the self-retaining retractors during surgery are pivotal to avoid this complication which transplant surgeons should be aware of.
Acute Femoral Neuropathy Following Renal Transplantation: A Retrospective, Multicenter Study in China
2010, Transplantation Proceedings
We investigated the relationship between the mode and duration of iliac artery anastomosis and acute femoral neuropathy (AFN).
A retrospective analysis was performed for 83 AFN cases from 6 transplantation centers in China. The incidence and nature of dysfunction of AFN were classified based upon the duration of iliac arterial anastomosis. No prisoners were used, and no organs from prisoners were used to obtain the data.
The incidence of AFN was 3.6% (53/1,449) in internal iliac anastomosis (group 1), 3.1% (11/346) in external iliac anastomosis (group 2) (P > .05 vs. group 1), and was 54.2% (19/35) in internal iliac ligation with external iliac anastomosis (group 3 P < .01 vs. groups 1 and 2). In group 1, the duration of the arterial anastomosis was ≤20 minutes in 1 case (1.9%), and >20 minutes in 52 cases (98.1%). In group 2, the duration of arterial anastomosis was ≤20 minutes in 1 case (9.0%) and >20 minutes in 10 cases (91%). In group 3, the duration of the arterial anastomosis was >20 minutes in all cases; 20 cases showed injury to the iliolumbar or deep iliac circumflex artery.
The incidence of AFN was associated with the selection of iliac arteries, the duration of the arterial anastomosis, and an injury to the iliolumbar or deep iliac circumflex artery.
Complications of the incision and patient positioning
2009, Complications of Urologic Surgery: Expert Consult
Pelvic Nerve Neuropathy After Kidney Transplantation
2007, Transplantation Proceedings
Citation Excerpt :
In conclusion, the incidence of femoral neuropathy after renal transplantation was 3.36 in our study with increased incidence among women, diabetics, and hypertensives.9
We examined the relation of various age, gender, diabetes, hypertension, and graft function with the prevalence of femoral and lateral cutaneous nerves sensory and/or motor disturbances after kidney transplantation.
Among 129 patients who underwent kidney transplantation from April 2001 to March 2002. We excluded, 10 due to preoperative sensory disturbances. We evaluated the prevalence of sensory and/or motor disturbances preoperatively by physical examination and postoperatively by both physical and electromyography examinations. The cinical findings were correlated with the following risk factors: age, gender, preoperative dialysis duration, background diseases. (e.g., diabetes, hypertension), graft weight, nephron mass index, operative and retraction time, and rejection episodes.
At 1 to 9 days postoperatively, 31 ng (26%) patients, suffered neuropathy of the lateral cutaneous nerve and 4 (3.3%), femoral neuropathy. No meaningful relation was detected between the incidence of neuropathy and these risk factors. The probability of neuropathy was greater among diabetics, hypertensives, women, and those with graft rejection episodes. All of these complaints were temporary.
Post-kidney transplant femoral and/or lateral cutaneous nerve neuropathy is a prevalent complication particularly in diabetic, hypertensive, and female patients. Neuropathy is also more evident after graft rejection.
Neurological complications in renal failure: A review
2004, Clinical Neurology and Neurosurgery
Neurological complications whether due to the uremic state or its treatment, contribute largely to the morbidity and mortality in patients with renal failure. Despite continuous therapeutic advances, many neurological complications of uremia, like uremic encephalopathy, atherosclerosis, neuropathy and myopathy fail to fully respond to dialysis. Moreover, dialytic therapy or kidney transplantation may even induce neurological complications. Dialysis can directly or indirectly be associated with dialysis dementia, dysequilibrium syndrome, aggravation of atherosclerosis, cerebrovascular accidents due to ultrafiltration-related arterial hypotension, hypertensive encephalopathy, Wernicke's encephalopathy, hemorrhagic stroke, subdural hematoma, osmotic myelinolysis, opportunistic infections, intracranial hypertension and mononeuropathy. Renal transplantation itself can give rise to acute femoral neuropathy, rejection encephalopathy and neuropathy in graft versus host disease. The use of immunosuppressive drugs after renal transplantation can cause encephalopathy, movement disorders, opportunistic infections, neoplasms, myopathy and progression of atherosclerosis. We address the clinical, pathophysiological and therapeutical aspects of both central and peripheral nervous system complications in uremia.

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¹: Department of Medicine University of California, Irvine 101 City Drive South Orange, California 92668

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Scientific articleCompression neuropathy subsequent to renal transplantation

Abstract

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

Peripheral Entrapment Neuropathies

Scientific article
Compression neuropathy subsequent to renal transplantation