Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and\nend-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was\ncompletely reversible after pericardectomy.\nCase presentation: A 43-year-old female caucasian patient received a living kidney donation from her mother. She\nhad developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease\nafter allogenic stem-cell transplantation for aplastic anemia.\nThe graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery,\nbut the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography\nshowed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion\nprofiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem\non ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive\nacute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused\nby severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis,\nwhich could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been\napparent on previous x-rays, computed tomography scans, or echocardiographies, including those for\ntransplantation evaluation.\nConservative management of the constrictive pericarditis was not successful and the graft remained anuric.\nEventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the\ngraft started urine production again, which significantly increased within a few days. The clearance improved and 2\nweeks later, the patient was free from dialysis.\nConclusions: This case illustrates that special attention should be given to the pericardium during transplant\nevaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation.
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