Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.0017
Jornal Vascular Brasileiro
Case Report

Acute renal artery thrombosis after kidney transplantation

Trombose aguda de artéria renal após transplante de rim

Murat Özban; Cagatay Aydin; Onur Birsen; Belda Dursun; Halil Erbis; Koray Tekin

Downloads: 0
Views: 118

Abstract

Early kidney transplant loss as a result of acute thrombosis of the renal artery remains a constant and devastating complication, with an incidence of 0.2-7.5%. While uncommon, arterial obstruction in the early postoperative period is a surgical emergency and must be ruled out if previously established diuresis ceases suddenly. Arterial thrombosis may occur as a result of injury to a diseased artery, problems with anastomoses, hypercoagulability or malpositioning of the allograft. In this study, we analyzed data on a group of 105 renal transplant recipients who presented with acute postoperative graft dysfunction between January 2006 and May 2012, to identify cases of acute renal artery thrombosis. We report on our experience of immediate re-transplantation following early kidney transplant thrombosis. Overall, two (1.9%) patients suffered early (within 48 hours of surgery) allograft renal artery thrombosis. In both patients, transplantation had not been complicated by atherosclerotic lesions or other thrombophilic states and postoperative diuresis had been successfully achieved, but diuresis ceased abruptly during the early postoperative period. Emergent duplex ultrasound scans were performed and acute renal artery thrombosis was detected in both patients. The patients were operated immediately and retransplantation procedures were conducted. We have reported our experience of immediate retransplantation following early primary graft dysfunction due to renal artery thrombosis. In conclusion, close monitoring of postoperative diuresis and, if necessary, immediate retransplantation in this situation can prove to be a successful treatment for preventing graft loss.

Keywords

renal artery, thrombosis, kidney transplantation

Resumo

A perda precoce de transplante renal resultante de trombose aguda da artéria renal permanece sendo uma complicação constante e devastadora, com uma incidência de 0,2-7,5%. Apesar de incomum, a obstrução da artéria no período pós-operatório imediato é uma emergência cirúrgica e deve ser descartada caso a diurese previamente estabelecida se interrompa de forma súbita. A trombose arterial pode ocorrer como resultado de dano à artéria previamente doente, problemas com anastomoses, hipercoagulabilidade ou mal posicionamento do enxerto. Neste estudo, analisamos os dados de 105 receptores de transplante renal que apresentaram disfunção aguda do enxerto no pós-operatório entre janeiro de 2006 e maio de 2012, para identificar casos de trombose aguda da artéria renal. Relatamos nossa experiência com retransplante imediato após trombose precoce de transplante renal. Ao todo, dois (1,9%) pacientes apresentaram trombose precoce (dentro de 48 horas após a cirurgia) da artéria renal do enxerto. Em ambos os casos, não haviam ocorrido complicações relacionadas a lesões ateroscleróticas ou outros estados trombofílicos durante o transplante, e a diurese pós-operatória havia sido estabelecida com sucesso, porém cessou bruscamente no pósoperatório imediato. Ecografia dúplex de emergência foi realizada e revelou trombose aguda de artéria renal nos dois pacientes. Os pacientes foram operados imediatamente, e foi realizado o retransplante. Relatamos nossa experiência com retransplante imediato após disfunção precoce do enxerto primário devido a trombose da artéria renal. Concluise que o monitoramento da diurese no pós-operatório e, se necessário, a realização do retransplante imediato nessa situação podem ser um tratamento bem-sucedido para evitar a perda do enxerto.

Palavras-chave

artéria renal, rombose, transplante renal

References

Keller AK, Jorgensen TM, Jespersen B. Identification of risk factors for vascular thrombosis may reduce early renal graft loss: A review of recent literature. J Transplant. 2012:1-9.

Knechtle SJ, Pirsch JD. Early course of the patient with a kidney transplant. Kidney Transplantation: Principles and Practice. 2008:210-9.

Fervenza FC, Lafayette RA, Alfrey EJ, Petersen J. Renal artery stenosis in kidney transplants. Am J Kidney Dis. 1998;31(1):142-8.

Humar A, Key N, Ramcharan T, Payne WD, Sutherland DE, Matas AJ. Kidney retransplants after initial graft loss to vascular thrombosis. Clin Transplant. 2001;15(1):6-10.

Markmann JF. Transplantation of abdominal organs. Sabiston Textbook of Surgery. 2007:703.

Phelan PJ, Magee C, O'Kelly P, O'Brien JF, Little D, Conlon PJ. Immediate re-transplantation following early kidney transplant thrombosis. Nephrology (Carlton). 2011;16(6):607-11.

Libicher M, Radeleff B, Grenacher L. Interventional therapy of vascular complications following renal transplantation. Clin Transplant. 2006;20(^sSuppl 17):55-9.

Humke U, Takahashi M, Siemer S, Uder M. Interventional radiologic management for early post-transplant perfusion failure of renal allografts. Aktuelle Urol. 2004;35(4):320-5.

Penny MJ, Nankivell BJ, Disney AP, Byth K, Chapman JR. Renal graft thrombosis. A survey of 134 consecutive cases. Transplantation. 1994;58(5):565-9.

5ddd7d940e88258a291da3e9 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections