In the OR, they removed a large amount of clot and old hemorrhage. There was s a small laceration seen at the posterior portion of the transplant renal parenchyma. There was some communication of old blood from the intra-abdominal portion into the retroperitoneum via the ovarian ligaments.
The most common surgical complications involving renal transplants are renal vein thrombosis, renal artery thrombosis, ureter obstruction, urine leak and a wound infection.1
Bleeding is uncommon after a surgery, and if it does occur, is usually due to unligated vessels in the graft hilum or from small severed retroperitoneal vessels of the recipient.1 In this patient, it was from a laceration to the donor kidney.
Risk factors for post-surgical bleeding include recipient obesity, antiplatelet agents, and anticoagulation.1
Abdominal ultrasound has been found to reliably detect between 250-620 mL of intraperitoneal fluid.2
Humar A, Matas AJ. Surgical complications after kidney transplantation. Semin Dial. 2005;18(6):505-10.
Rose J. Ultrasound in Abdominal Trauma. Emerg Med Clin N Am 2004;22:581-99