This case report describes rare intraoperative complications during renal allotransplantation. A 59-year-old man underwent an expanded criteria deceased donor renal transplantation. A wedge biopsy, as per institution protocol, was performed prior to surgery. After vascular anastomoses, the kidney was reperfused; immediate significant hematuria was noted from the ureter. After exploration, compression of the wedge biopsy site stopped the bleeding, suggesting a venous-calyceal fistula. An incision at the wedge biopsy site was made to do an open repair, yielding a small suspicious lesion. Frozen section confirmed clear cell renal carcinoma, which was completely resected. The hematuria resolved after renorrhaphy, and we proceeded with ureteral reimplantation. Postoperatively, the patient was maintained on immunosuppression, free of recurrence at eight months. The surgeon must be aware of the possibilities of unusual complications as well as treatment options. This study provides a treatment strategy to address these challenging intraoperative complications.
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