Kidney Week

Abstract: TH-PO569

Transplant Renal Artery Thrombosis: Uncommon Complication of Acute Rejection

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

• Yi, Jia, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Jia Yi,

• Kshirsagar, Abhijit V., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Abhijit V. Kshirsagar,

• Detwiler, Randal K., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Randal K. Detwiler,

• Singh, Harsharan Kaur, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States

Harsharan Kaur Singh,

• Burke, Charles, University of North Carolina, Chapel Hill, North Carolina, United States

Charles Burke,

Introduction

Acute transplant renal artery thrombosis is rare, primarily seen in the immediate post-transplant setting related to surgical complication. We present a case of acute transplant renal artery thrombosis in a patient receiving treatment for acute cellular and antibody mediated rejection.

Case Description

21 year old female with a stable renal transplant for 3 years (baseline creatinine 0.8 mg/dl) was admitted for acute kidney injury (creatinine 7.41) after not taking her immunosuppression due to gastroenteritis. She began empiric pulse dose methylprednisolone on presentation. Allograft biopsy on hospital day 3 showed acute cellular and antibody mediated rejection. She was started on thymoglobulin and plasma pheresis with initial improved renal function (creatinine 3.39). On hospital day 7, she began to have a progressive decline in urine output and kidney function. Doppler ultrasound revealed minimal perfusion to the transplant [Fig 1a]. Repeat kidney biopsy had near total renal infarction [Fig 2]. Confirmatory CT angiogram [Fig 1b] revealed no flow in the transplant renal artery. She re-initiated hemodialysis.

Discussion

Acute transplant renal artery thrombosis should be considered if anuria develops while being treated for allograft rejection. Prompt diagnosis and intervention is essential to prevent graft loss, unfortunately the most common outcome.