Acute Thrombosis of the Renal Transplant Artery after a Single Dose of OKT3

Shankar, Ravi; Bastani, Bahar; Salinas-Madrigal, Luis; Sudarshan, Ballal

doi:10.1159/000046237

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…Other rare causes include acute rejection episodes, external compression by adjacent hematoma or lymphocele, hypercoagulative state, severe hypotension, toxicity from immunosuppressive agents such as cyclosporine or sirolimus, and administration of OKT3, especially when used in combination with high doses of methylprednisolone. 16,17 Transplant RAT is a surgical emergency. Immediate exploration is the only chance to save the transplanted kidney.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Tavakkoli

Zafarghandi²,

Taghavi³

et al. 2017

Exp Clin Transplant

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Objectives: Vascular complications, especially immediate events during kidney transplant, are the major cause of graft loss, and prompt surgical intervention is important for salvage of the graft and recipient. In this study, our aim was to show our experiences with vascular interventions and their effects on graft outcomes in transplant patients with suspected immediate vascular events. Materials and Methods: Over 24 years (from 1990 to 2014), 2100 renal transplant procedures (1562 living and 538 deceased donors) were performed by one fixed team. We reviewed the recipients to find cases with immediate vascular complications, including artery or vein kinking or torsion, renal artery thrombosis, and renal vein thrombosis. Diagnosis of a vascular event was suspected when urinary output suddenly stopped and was confirmed by color Doppler ultrasonography or immediate exploration. Characteristics of the patients and events, surgical interventions for saving grafts, and graft outcomes were assessed. Results: Our study included 28 vascular accidents (1.3% of total renal transplants). Arterial kinking or torsion, venous kinking or torsion, renal artery thrombosis, and renal vein thrombosis occurred in 11 (0.52%), 2 (0.09%), 12 (0.57%), and 3 patients (0.14%). Nine of the 11 cases of arterial kinking occurred with use of internal iliac artery. Eleven of 13 grafts with vascular kinking or torsion were saved by immediate surgical intervention, but only 4 grafts in patients with renal artery thrombosis and only 1 graft in patients with renal vein thrombosis were saved by surgical intervention. Delayed graft function occurred in all cases of saved renal artery and renal vein thrombosis but only in 5 cases (4 arterial and 1 venous) of vascular kinking or torsion. Conclusions: The incidence of immediate vascular complications was 1.3% in our study. Sudden cessation of urine after renal transplant is a warning sign, and immediate diagnosis of vascular events will help salvage the graft with proper intervention.

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Section: Discussionmentioning

confidence: 99%

Untitled

Tavakkoli

Zafarghandi²,

Taghavi³

et al. 2017

Exp Clin Transplant

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“…[3] Administration of OKT3 has been found to increase risk of thrombosis in allograft artery, especially when used in combination with high doses of methylprednisolone. [45] Transplant renal artery thrombosis is a surgical emergency and only hope to save the transplanted kidney is by immediate exploration with restoration of the blood flow to the kidney. A few cases of graft salvage in transplant renal artery thrombosis with endovascular catheter directed thrombolysis with or without angioplasty have been reported.…”

Section: Discussionmentioning

confidence: 99%

Vascular complication in live related renal transplant: An experience of 1945 cases

et al. 2013

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Introduction and Objective:Among the surgical complications in renal transplantation, the vascular complications are probably most dreaded, dramatic, and likely to cause sudden loss of renal allograft. We present our experience and analysis of the outcome of such complications in a series of 1945 live related renal transplants.Materials and Methods:One thousand nine hundred and forty five consecutive live related renal transplants were evaluated retrospectively for vascular complications. Complications were recorded and analyzed for frequency, time of presentation, clinical presentation, and their management.Results:The age of patients ranged from 6 to 56 years (mean = 42). Vascular complications were found in 25 patients (1.29%). Most common among these was transplant renal artery stenosis found in 11 (0.58%), followed by transplant reznal artery thrombosis in 9 (0.46%), renal vein thrombosis in 3 (0.15%), and aneurysm formation at arterial anastmosis in 2 (0.10%) patient. The time of presentation also varied amongst complications. All cases of arterial thrombosis had sudden onset anuria with minimal or no abdominal discomfort, while venous thrombosis presented as severe oliguria associated with intense graft site pain and tenderness. Management of cases with vascular thrombosis was done by immediate surgical exploration. Two patients of renal artery stenosis were managed with angioplasty and stent placement.Conclusions:Major vascular complications are relatively uncommon after renal transplantation but still constitute an important cause of graft loss in early postoperative period. Aneurysm and vessel thrombosis usually require graft nephrectomy. Transplant renal artery stenosis is amenable to correction by endovascular techniques.

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“…The increase in cardiovascular deaths in the early period after renal transplantation might be explained by either the procoagulant effects of these drugs or perhaps the stress of the cytokine release accompanying the administration of these biologic agents (15)(16)(17). The long-term cardiovascular risk might be related to early cardiovascular damage, which translates into increased late cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 99%

Association of Antibody Induction with Short- and Long-Term Cause-Specific Mortality in Renal Transplant Recipients

Meier-Kriesche

Arndorfer

Kaplan

2002

Journal of the American Society of Nephrology

113

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ABSTRACT. A total of 73,707 primary renal transplants reported to the USRDS between 1988 and 1997 were examined to investigate the cause-specific risk for patient death associated with anti-lymphocyte antibody induction therapy (ABI). Cox proportional hazard models were used to estimate the relative risk of the use of ABI and patient death. All Cox models were corrected for potential confounding variables, such as age, gender, race, HLA mismatch, panel reactive antibody, delayed graft function, cold ischemia time, time since start of dialysis, etiology of end-stage renal disease, cytomegalovirus risk group, donor source (living or cadaveric), era effect, and immunosuppressive therapy. Primary study end points were patient death with functioning graft (DWFG) and overall patient death, including death after graft loss. Early patient death (deaths within the first 6 mo after renal transplantation) and late death (deaths after 6 mo post–renal transplantation) were investigated separately. Additionally, specific causes of death were investigated. ABI was associated with a significant risk for late death after renal transplantation (relative risk [RR] = 1.1; P < 0.001) but not for DWFG (RR = 0.94; P = 0.10). ABI conferred the highest RR for late malignancy–related death (RR = 1.35; P < 0.001). ABI was significantly associated with early deaths due to infection and cardiovascular causes (RR = 1.32 [P < 0.001] and RR = 1.27 [P < 0.001], respectively). Kaplan Meier plots confirmed that the risk of ABI for patient death secondary to infectious complications was increased predominately early after transplantation as opposed to late for malignancy-related death. ABI was associated with a significant relative risk for patient death secondary to cardiovascular causes and infectious complications early in the posttransplant period. In addition, ABI was associated with a significant risk for long-term malignancy-related death. The risk of ABI should be taken in context with potential benefits of this therapy.

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Acute Thrombosis of the Renal Transplant Artery after a Single Dose of OKT3

Cited by 16 publications

References 29 publications

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Vascular complication in live related renal transplant: An experience of 1945 cases

Association of Antibody Induction with Short- and Long-Term Cause-Specific Mortality in Renal Transplant Recipients

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