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Abstract: TH-PO570

Delayed Graft Failure Secondary to Renal Vein Thrombosis in a Patient with a Permanent IVC Filter

Session Information

  • Trainee Case Reports - II
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 1802 Transplantation: Clinical

Authors

  • Lewis, Kristyn L., Mayo Clinic, Jacksonville, Florida, United States
  • Patel, Payal P., Mayo Clinic, Jacksonville, Florida, United States
  • Gil, Laura, Mayo Clinic, Jacksonville, Florida, United States
  • Frey, Gregory, Mayo Clinic, Jacksonville, Florida, United States
  • Wadei, Hani, Mayo Clinic, Jacksonville, Florida, United States
  • Guru, Pramod K., Mayo Clinic, Jacksonville, Florida, United States
Introduction

Transplanted renal vein thrombosis (RVT) is a rare cause of delayed graft failure in renal transplant patients. The estimated prevalence of graft vein thrombosis is 0.1% to 4.2%, mostly occurring in the early transplant period. The associated morbidity is devastating, given the high risk of permanent graft failure. Patient and donor related factors, along with multiple perioperative events, and immunosuppressive agents are incriminated for venous thrombosis in the early transplant period. We describe herein, an unusual case of RVT leading to severe graft failure after ten years of transplantation.

Case Description

A 53-year-old male with a deceased donor renal transplant 10 years prior, for suspected glomerulonephritis, was admitted to the hospital with progressive bilateral lower extremity swelling, decreased urine output and weakness. One week prior, he was treated for suspected urinary tract infection at an outside facility. His graft function had been stable with a baseline creatinine 1.3-1.5 mg/dl on tacrolimus and mycophenolate. On evaluation, with help of ultrasonography and computed tomography, he was noted to have bilateral venous thromboses of iliac and popliteal veins with an extension into the transplanted renal vein. He was also noted to have a filter in his inferior vena cava, inserted in 2002. The patient was managed by catheter directed thrombolysis with help of tissue plasminogen activator (tPA), as well as systemic heparin therapy. His hospital course was complicated by acute severe graft dysfunction needing initiation of renal replacement therapy, and development of an anticoagulation related rectus sheath hematoma. His RVT showed partial resolution along with recovery of graft function in the ensuing two weeks. He was discharged on oral anticoagulation and off dialysis. Recent infection, obesity, a retained IVC filter, and possible undiagnosed hypercoagulable states were considered to have played roles in the thrombosis in this case.

Discussion

This case describes an atypically late presentation of transplanted renal vein thrombosis years after renal transplant. This case exemplifies both the risks associated with RVT, and the need for astute clinical vigilance for the early detection and timely initiation of appropriate therapy to salvage the precious graft in transplanted patients.