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Background <p>Page kidney secondary to subcapsular hematoma (SH) is a rare but serious complication in renal transplant recipients, typically occurring in the early postoperative period. This is caused by external graft compression, which impairs perfusion and leads to acute renal dysfunction. Prompt diagnosis and surgical intervention are essential for salvaging graft functions.</p> Objective <p>This systematic review synthesizes available case-level evidence on Page kidney in transplant recipients, focusing on the timing of onset, clinical presentation, imaging characteristics, management strategies, and outcomes of Page kidney.</p> Methods <p>A systematic search of the PubMed, Scopus, Embase, Web of Science, and Google Scholar databases was conducted until May 2024. Eligible studies included case reports and case series describing Page kidneys due to SH in renal transplant recipients. Data extraction included clinical features, imaging findings, interventions, and outcomes. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. This review was registered with PROSPERO (CRD42024547165; University of York, UK).</p> Results <p>Ten studies involving 15 patients were included in the analysis. Most patients (13/15) developed Page kidney within the first week after transplantation, while two cases presented &gt; 6&#xa0;months after transplantation. Common features included oliguria or anuria (86.7%), elevated resistive indices (RI ≥ 0.9), and crescentic subcapsular hematomas on Doppler ultrasound. Surgical evacuation was performed in 93.3% of the cases, with favorable renal recovery in 11 patients (73.3%). Late or missed diagnoses are correlated with irreversible graft losses. The risk of bias was low in all included studies.</p> Conclusion <p>Page kidney in transplant recipients, although rare, requires a high index of suspicion, particularly in the early postoperative period. Doppler ultrasonography remains central to diagnosis, while surgical decompression offers the best chance of graft salvage. Early recognition is critical given the narrow therapeutic window and high stakes of delayed intervention.</p>

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Page kidney secondary to subcapsular hematoma in renal transplant recipients: a systematic review of reported cases

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Sundus Dadan,
  • Wajahat Mirza,
  • Mohammad Ayaz Khan

摘要

Background

Page kidney secondary to subcapsular hematoma (SH) is a rare but serious complication in renal transplant recipients, typically occurring in the early postoperative period. This is caused by external graft compression, which impairs perfusion and leads to acute renal dysfunction. Prompt diagnosis and surgical intervention are essential for salvaging graft functions.

Objective

This systematic review synthesizes available case-level evidence on Page kidney in transplant recipients, focusing on the timing of onset, clinical presentation, imaging characteristics, management strategies, and outcomes of Page kidney.

Methods

A systematic search of the PubMed, Scopus, Embase, Web of Science, and Google Scholar databases was conducted until May 2024. Eligible studies included case reports and case series describing Page kidneys due to SH in renal transplant recipients. Data extraction included clinical features, imaging findings, interventions, and outcomes. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. This review was registered with PROSPERO (CRD42024547165; University of York, UK).

Results

Ten studies involving 15 patients were included in the analysis. Most patients (13/15) developed Page kidney within the first week after transplantation, while two cases presented > 6 months after transplantation. Common features included oliguria or anuria (86.7%), elevated resistive indices (RI ≥ 0.9), and crescentic subcapsular hematomas on Doppler ultrasound. Surgical evacuation was performed in 93.3% of the cases, with favorable renal recovery in 11 patients (73.3%). Late or missed diagnoses are correlated with irreversible graft losses. The risk of bias was low in all included studies.

Conclusion

Page kidney in transplant recipients, although rare, requires a high index of suspicion, particularly in the early postoperative period. Doppler ultrasonography remains central to diagnosis, while surgical decompression offers the best chance of graft salvage. Early recognition is critical given the narrow therapeutic window and high stakes of delayed intervention.