Deceased donor interposition graft repair of superior mesenteric artery injury during cytoreductive nephrectomy for metastatic renal cell carcinoma

Abstract Iatrogenic injury to the superior mesenteric artery (SMA) represents a rare but serious complication of nephrectomy, associated with significant morbidity and mortality. Repair can be technically challenging. We describe the case of a 71-year-old patient who had an SMA injury during an open nephrectomy for a large carcinoma. Her SMA was reconstructed successfully using a deceased-donor iliac artery interposition graft. Due to her high-risk pathology and progressive disease early in the post-operative period, she was commenced on lenvatinib and pembrolizumab. Despite the vascular allograft, immunosuppression was not used due to concerns about an interaction with immunotherapy. To date, she has had an excellent treatment response with a significant reduction in metastatic burden without the development of rejection of the vascular allograft, despite no immunosuppression.