Renal Allograft Thrombosis in the Early Post Transplant Period

Case Report of Patient With Venous Thrombosis of the Transplanted Kidney in the Early Postoperative Period

Renal allograft thrombosis is not a rare complication of kidney transplant and usually occurs in the early period after transplant, but it can also occur later after transplant. Several factors are associated with this infamous complication. The cause of venous anastomosis thrombosis is most often inflection or twisting of the renal vein, anastomosis stenosis, hypotension, hypercoagulation, or acute rejection of the graft. Doppler ultrasonography can allow identification of signs of thrombosis in the graft vein. With early diagnosis and timely intervention, graft function can be preserved and restored. Here, we describe a 13-year-old boy with a diagnosis of chronic kidney disease that was detected in 2017. He underwent kidney transplant, and the donor was a cousin from his mother's side of the family. HLA compatibility showed HLA-A, HLA-B, and HLADR matches, with 10% cross-matches. The patient underwent heterotopic kidney transplant in the right iliac region with the imposition of an end-toside anastomosis between the kidney artery and the external iliac artery and between the renal vein and external iliac vein. After surgery, the patient's hourly diuresis did not exceed 50 mL/hour. Graft Doppler ultrasonography showed a reversible blood flow of the graft vessels with high vascular resistance index. We suspected venous anastomosis thrombosis, and the patient was urgently taken to the operating room for revision. When the external iliac vein was opened below the anastomosis, thrombosis of the external iliac vein occurred with spread of the graft to the vein, completely covering the lumen of the vein. Thrombectomy was performed with reperfusion of the transplanted kidney with Custodial solution through the artery opening. The external iliac vein and artery opening were sutured. After blood flow started, the size, consistency, and color of the kidney returned to normal.