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Kidney Week

Abstract: PO2169

Treatment of Transplant Renal Vein Thrombosis in a Pediatric Patient Using an EkoSonic Endovascular System (EKOS) Catheter

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Shah, Siddharth A., University of Louisville, Louisville, Kentucky, United States
  • Prasad, Malavika, University of Louisville, Louisville, Kentucky, United States

Group or Team Name

  • Pediatric Nephrology team
Introduction

Transplant renal vein thrombosis (tRVT) is a critical complication after renal transplant with reported prevalence of 0.1% to 4.2% leading mostly to graft loss. Thrombolytic therapy and surgical thrombectomy has been described previously to treat tRVT. EKOS is a modern and innovative ultrasound-facilitated catheter directed thrombolysis technique that is approved primarily for treatment of pulmonary embolism, deep vein thrombosis and arterial occlusion. It requires ultrasound core wire and infusion catheter for delivery of fibrinolytic agent such as Tissue plasminogen activator (tPA). The ultrasound core wire or transducer generates ultrasound waves that help accelerate fibrinolysis,decrease the treatment time and decrease the risk of bleeding. The use of EKOS for tRVT has not been reported in pediatric literature and we describe one such case.

Case Description

We describe a 17-year-old boy with history of congenital nephrotic syndrome who received living donor renal transplant in 2005. His post-transplant course was complicated by multiple episodes of deep venous thrombosis in right lower extremity, chronic right inguinal venous thrombosis with collaterals in lower extremities,maintained on anticoagulant therapy. He presented with serum creatinine elevation of 3.7 mg/dL (baseline of 1.4 mg/dL) and anuria. On renal US Doppler, the transplant renal vein was not seen and there was concern of lack of flow/RVT. CT venogram performed showed acute lumen occluding thrombus in left lower extremity venous system extending from left popliteal and femoral vein all the way to the left transplant renal vein in the left iliac fossa. He received tPA as per hematology without any improvement. Active discussions between hematology,nephrology and vascular surgery led to a trial of EKOS device to salvage the allograft. The patient then underwent thrombolysis using EKOS catheter with peripheral access to the left transplant renal vein, without any complications. The repeat renal US Doppler showed patent left renal transplant vein, with continued occlusion in the left external iliac vein. The serum creatinine returned to baseline 1.4-1.5 mg/dL one week after procedure.

Discussion

We describe a novel report of successful treatment of transplant renal vein thrombosis using EKOS catheter. Further studies are needed to provide more insight in this therapy.