Clinical Utility of Ultrasound in Detecting Subcapsular Hematoma after ABO Incompatible Kidney Transplantation

A subcapsular hematoma after kidney transplantation is a rare but potentially graft-threatening complication that can result in the Page kidney phenomenon. Early diagnosis and timely management are critical to preserve the graft function. This paper reports a case in which ultrasound played a pivotal role in the early detection and surgical management of a subcapsular hematoma after ABO-incompatible kidney transplantation. Case presentation: a 42-year-old woman with end-stage renal disease secondary to diabetes and hypertension underwent ABO-incompatible kidney transplantation from her 21-year-old daughter. On postoperative day (POD) 5, the patient developed mild tenderness at the graft site and a sudden decrease in urine output. Doppler ultrasound revealed a subcapsular hematoma compressing the graft parenchyma, with a resistive index (RI) of 0.9-1.0, indicative of the Page kidney phenomenon. Emergency surgical exploration confirmed an 8-cm subcapsular hematoma, which was evacuated successfully through capsulotomy. Postoperatively, the patient’s renal function improved rapidly, and she was discharged without further complications. This case underscores the clinical utility of ultrasound for the early detection of subcapsular hematoma after kidney transplantation. Prompt ultrasound assessment enables timely intervention and may significantly improve graft survival.