Spontaneous Retroperitoneal Hemorrhage From Lumbar Artery Rupture Following Renal Transplantation in a Longterm Hemodialysis Patient: Graft Salvage Without Nephrectomy

Spontaneous retroperitoneal hemorrhage after renal transplantation is exceedingly uncommon and may be misinterpreted as graft-related pathology. Prolonged dialysis predisposes patients to vascular fragility due to atherosclerosis and medial calcification. We describe a case of a 29-year-old man on long-term hemodialysis who developed acute retroperitoneal bleeding from ruptured lumbar arteries one week following deceased donor transplantation. The patient presented with abdominal distension, shock, and precipitous hemoglobin drop. Urgent CT angiography identified active extravasation from the 1st, 3rd, and 4th lumbar arteries. Successful transarterial embolization was achieved using metallic coils and polyvinyl alcohol particles, avoiding graft nephrectomy. Renal function subsequently recovered, and the patient was discharged with stable graft function. This report emphasizes the diagnostic importance of vascular imaging and highlights interventional radiology as a lifesaving strategy in post-transplant hemorrhage not attributable to the allograft.