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Abstract: FR-PO739

Rare Case of Renal Vein Thrombosis in a Transplanted Kidney with Successful Endovascular Thrombectomy

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Soney, Hywel, Methodist Dallas Medical Center, Dallas, Texas, United States
  • Serrano-Santiago, Victor E., Methodist Dallas Medical Center, Dallas, Texas, United States
  • Fa, Kosunarty, Methodist Dallas Medical Center, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States

Transplant-associated renal vein thrombosis (RVT) is a rare complication in kidney transplant recipients, with high risk of allograft loss and further complications. Here, we present a case of RVT managed by endovascular thrombectomy.

Case Description

A 75-year-old African American female with a history of ESRD due to T2DM, underwent deceased donor renal allograft implantation with Thymoglobulin induction, maintenance with mycophenolate, tacrolimus, and prednisone, and was discharged without complications and stable Creatinine (Cr) 1.0 mg/dL. She was readmitted 4 weeks after transplant for diminished urine output, hypotension, and elevated Cr (2.8 mg/dL). Urinalysis on admission demonstrated >100 red blood cells along with 5-10 white blood cells. Doppler ultrasound demonstrated elevated intrarenal resistive indices, reversed diastolic flow in the renal artery, deep vein thrombosis from the right common femoral vein through the popliteal vein, and with a nonocclusive thrombus in the iliac vein straddling the anastomosis. With high suspicion for RVT, the patient underwent a successful endovascular thrombectomy. Follow-up renal ultrasound demonstrated normalized transplant renal flow dynamics and correction of the reversed diastolic flow in the iliac arteries. Allograft biopsy was performed with findings of acute tubular necrosis and no evidence of rejection. During this time, the patient’s Cr peaked at 6.9 mg/dL with intermittent need for vasopressors and continuous renal replacement therapy. Within the following two weeks, the patient’s urine output and Cr recovered to baseline status and she was continued on anticoagulation thereafter.


RVT in new transplants has a high risk of poor outcomes. Events usually occur within the first two weeks and can present with worsening renal function, oliguria, hematuria, and/or abdominal pain. Early detection with Doppler ultrasound is key to evaluating for potential RVT and initiating further diagnostic actions or interventions to prevent complications. Interventions may include direct surgical thrombectomy, endovascular thrombectomy or thrombolytic therapy, although studies are lacking in identifying an optimal first-line intervention. Having a high suspicion for RVT and acting quickly is vital in avoiding critical complications in new allografts.