Iatrogenic-related transplant injuries: the role of the interventional radiologist

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

Background: In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Case summary: Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient's condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. Conclusions: If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.

Uncommon Complications in the First Year After Renal Transplantation

INTRODUCTION

Classic post-transplant complications are highly studied and monitored; however, other unusual complications may occur due to immunosuppression. The objective of this study is to show these rare complications in a kidney transplant center.

MATERIAL AND METHODS

Retrospective, observational, longitudinal study of renal transplants carried out from 2013 to 2017 in the Renal Transplant Unit of the National Medical Center Siglo XXI. A total of 790 transplants were performed, with surveillance for 1 year and rare events described. An analysis of frequencies and percentages of the events was performed using the statistical package SPSS version 25.

RESULTS

Of the 790 patients, 110 (13.92%) experienced rare events, classified into 9 types of complications.

DISCUSSION AND CONCLUSIONS

Complications exist in renal transplantation that are often ignored or minimized. A considerable number have been observed in this study, 110 events (13.92%); this result allows us to consider multiple possibilities in a kidney transplant program, especially infectious complications (34 patients) and surgical complications (29 cases). With the increase in diabetic receptor transplantation, metabolic complications will surely increase in the coming years.