Bench thrombolysis and "autotransplantation" as a rescue treatment for venous thrombosis after living-donor kidney transplantation.
kidney transplantation
pediatric
thrombolysis
thrombosis of the inferior vena cava
venous thrombosis
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
06
05
2021
received:
30
03
2021
accepted:
02
06
2021
pubmed:
24
6
2021
medline:
3
2
2022
entrez:
23
6
2021
Statut:
ppublish
Résumé
Allograft venous thrombosis is a severe complication after kidney transplantation (KT). Early diagnosis and prompt treatment are crucial in preserving the survival of the allograft. In this study, we aimed to describe an emergent strategy for the management of acute allograft venous thrombosis. A 4-year-old girl, weighing 13.5 kg, was diagnosed with bilateral congenital renal hypodysplasia, urogenital sinus and anorectal malformation. The patient was referred to our department for living-donor KT. Her mother was eligible as a donor, presenting a body weight ratio of 1:4.5. Thrombosis of the inferior vena cava (ICV) was also identified, without any predisposing factor for thrombophilia. KT was performed by an extraperitoneal approach without complications. Venous anastomosis required a human vascular graft sutured to the ICV, and renal artery was anastomosed to the aorta. On postoperative day (POD) 8, acute abdominal pain and hematuria led to the diagnosis of an allograft venous thrombosis. An emergent laparotomy was required to explant the allograft, followed by bench surgery. The allograft was irrigated with thrombolytic agents and lactated Ringer's solution and then after removing the venous vascular graft, it was reimplanted through vascular anastomosis with the ICV and aorta. The recovery of perfusion and function was good with diuresis since day 4 after re-surgery. At 2-year follow-up, the child presented normal allograft function with an estimated GFR of 65 ml/min/1.73 m According to our experience, explantation of the kidney allograft, followed by irrigation with thrombolytics in bench surgery, and reimplantation resulted in unexpected optimal outcomes in the case of allograft venous thrombosis.
Sections du résumé
BACKGROUND
BACKGROUND
Allograft venous thrombosis is a severe complication after kidney transplantation (KT). Early diagnosis and prompt treatment are crucial in preserving the survival of the allograft. In this study, we aimed to describe an emergent strategy for the management of acute allograft venous thrombosis.
CASE PRESENTATION
METHODS
A 4-year-old girl, weighing 13.5 kg, was diagnosed with bilateral congenital renal hypodysplasia, urogenital sinus and anorectal malformation. The patient was referred to our department for living-donor KT. Her mother was eligible as a donor, presenting a body weight ratio of 1:4.5. Thrombosis of the inferior vena cava (ICV) was also identified, without any predisposing factor for thrombophilia. KT was performed by an extraperitoneal approach without complications. Venous anastomosis required a human vascular graft sutured to the ICV, and renal artery was anastomosed to the aorta. On postoperative day (POD) 8, acute abdominal pain and hematuria led to the diagnosis of an allograft venous thrombosis. An emergent laparotomy was required to explant the allograft, followed by bench surgery. The allograft was irrigated with thrombolytic agents and lactated Ringer's solution and then after removing the venous vascular graft, it was reimplanted through vascular anastomosis with the ICV and aorta. The recovery of perfusion and function was good with diuresis since day 4 after re-surgery. At 2-year follow-up, the child presented normal allograft function with an estimated GFR of 65 ml/min/1.73 m
CONCLUSION
CONCLUSIONS
According to our experience, explantation of the kidney allograft, followed by irrigation with thrombolytics in bench surgery, and reimplantation resulted in unexpected optimal outcomes in the case of allograft venous thrombosis.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14074Informations de copyright
© 2021 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.
Références
Wang C, Greenbaum LA, Patzer RE, et al. Renal allograft loss due to renal vascular thrombosis in the US pediatric renal transplantation. Pediatr Nephrol. 2019;34(9):1545-1555.
Irtan S, Maisin A, Baudouin V, et al. Renal transplantation in children: critical analysis of age-related surgical complications. Pediatr Transplant. 2010;14(4):512-519.
Kranz B, Vester U, Nadalin S, Paul A, Broelsch CE, Hoyer PF. Outcome after kidney transplantation in children with thrombotic risk factors. Pediatr Transplant. 2006;10(7):788-793.
De Coppi P, Giuliani S, Fusaro F, et al. Cadaver kidney transplantation and vascular anomalies: a pediatric experience. Transplantation. 2006;82(8):1042-1045.
Kim JK, Chua ME, Teoh CW, et al. Assessment of prophylactic heparin infusion as a safe preventative measure for thrombotic complications in pediatric kidney transplant recipients weighing <20 kg. Pediatr Transplant. 2019;23(6):e13512.
Baxter GM. Ultrasound of renal transplantation. Clin Radiol. 2001;56(10):802-818.
Gulati A, Sarwal MM. Pediatric renal transplantation: an overview and an update. Curr Opin Pediatr. 2010;22(2):189-196.
Donati-Bourne J, Roberts HW, Coleman RA. Donor-recipient size mismatch in paediatric renal transplantation. J Transplant. 2014;2014:1-5.
Szymczak M, Kalicinski P, Rubik J, et al. Kidney transplantation in children with thrombosed inferior caval vein - atypical vascular anastomoses. Ann Transplant. 2019;24:25-29.
Salvatierra OJ, Concepcion W, Sarwal MM. Renal transplantation in children with thrombosis of the inferior vena cava requires careful assessment and planning. Pediatr Nephrol. 2008;23(12):2107-2109.
Gander R, Asensio M, Fatou Royp G, et al. Vascular thrombosis in pediatric kidney transplantation: graft survival is possible with adequate management. J Pediatr Urol. 2018;14(3):222-230.
Ismail H, Kalicinski P, Drewniak T, et al. Primary vascular thrombosis after renal transplantation in children. Pediatr Transplant. 1997;1(1):43-47.
Alammedine M, Moghadamyeghaneh Z, Yusufali A, et al. Kidney autotransplantation: between the past and the future. Curr Urol Rep. 2018;19(3):7.
Tan RY, Pang SC, Teh SP, et al. Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access. J Vasc Access. 2019;20(5):501-506.