Perirenal Hematoma and Graft Malposition Requiring Surgical Repositioning After Transplant Tourism: A Case Report

Introduction: Patients returning after transplant tourism often have incomplete perioperative information, complicating postoperative management and clinical decision-making. Case Presentation: A 72-year-old Japanese man with end-stage kidney disease secondary to diabetic nephropathy underwent living-donor kidney transplantation abroad. After returning to Japan, he developed decreased urine output and lower back pain. Contrast-enhanced computed tomography revealed the transplanted kidney in the subcutaneous tissue of the right lower abdomen, with perirenal gas/fluid collection and a partially non-enhancing lesion in the renal parenchyma. Because bowel injury could not be excluded, exploratory laparotomy was performed. Intraoperatively, the graft was identified in the subcutaneous layer with surrounding hematoma and was repositioned into the subfascial iliac fossa. Postoperatively, graft function remained stable without pathological abnormalities. Conclusion: Transplant tourism may involve substantial deviation from standard surgical practice and poses significant clinical and ethical challenges for physicians.