Abstract: FR-PO740
Transplant Renal Vein Thrombosis
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Shah, Monarch, University of Virginia, Charlottesville, Virginia, United States
- Rao, Swati, University of Virginia, Charlottesville, Virginia, United States
- Nishio Lucar, Angie G., University of Virginia, Charlottesville, Virginia, United States
Introduction
Transplant renal vein thrombosis (TRVT) is a dire complication of kidney transplantation and can lead to graft failure. This case highlights the importance of awareness of this infrequent complication and the importance of reviewing donor anatomy to assist in timely diagnosis.
Case Description
A 40-year-old male with ESKD due to IgAN diagnosed at 17 was on peritoneal dialysis since age 36 and underwent a deceased donor kidney transplant (KT). The KDPI was 12%, calculated PRA were 0%, and EPTS was 13%. The donor renal artery was anastomosed to the recipient’s external iliac artery. As the right renal vein (RV) is shorter an IVC extension graft is utilized for anastomosis. Despite the atypical incision on the donor IVC, the surgeon achieved a good extension for anastomosis to the recipient’s external iliac vein. The kidney perfused well with immediate graft function. Immunosuppression induction was with anti-thymocyte globulin and steroids and maintenance with MMF and tacrolimus. Creatinine improved to 1.8 mg/dl by POD4 (9.4 mg/dl preoperatively). He was re-admitted on POD 8 with hematuria, abdominal pain & reduced urine output. Creatinine was 2.4 mg/dl. CT scan showed a hypoattenuating KT. Ultrasound (fig A) showed diastolic reversal of arterial flow and absence of RV doppler signal. Venography showed thrombosis of the transplant RV up to the anastomosis. Rheolytic thrombectomy of the transplanted RV, balloon angioplasty (Fig B), and stent placement of the juxta-anastomotic stenosis was done with fast outflow (Fig C) seen from the allograft. The allograft was salvaged & urine output is > 1L/day, but he is dialysis dependent. The venous stent thrombosed 2 months post-transplant requiring thrombectomy and balloon angioplasty. Currently, the allograft outcome remains guarded.
Discussion
AKI in transplant patients has a broad differential, and there should be a high suspicion index for TRVT. Knowing donor anatomy and the operative course aids in rapid diagnosis. Despite prompt therapy, TRVT causes profound ischemic damage leading to allograft loss and nephrectomy.
A: Diastolic reversal of arterial flow, B: Balloon angioplasty of the juxta-anastomotic segmental stenosis, C: Fast outflow from the allograft