Endovascular Treatment of Renal Artery Thrombosis in Living-Donor Kidney Transplant Recipient With Severe COVID-19 Disease

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) patients have a higher prevalence of micro-and macrovascular thrombotic events. However, the underlying mechanism for the increased thrombotic risk is not completely understood. Solid organ transplant recipients infected with SARS-CoV-2 may have an exponential increase in thrombotic risk and the best management strategy is unknown. Case Report: A female kidney transplant recipient presented with allograft’s renal artery thrombosis after a recent COVID-19 infection. Due to the risk of kidney failure or exclusion, catheter directed thrombolysis was performed. Residual thrombus was excluded using an endoprosthesis with an excellent result. There were no adverse events and kidney function improved. Conclusion: This paper reports the endovascular treatment of renal artery thrombosis in a living-donor kidney transplant recipient with severe COVID-19 disease.

Management of the kidney transplant recipient in the intensive care unit

“…Diagnosis is made when no blood flow is seen on transplant doppler ultrasound. If the diagnosis is made immediately, the allograft may be salvaged by emergent arteriotomy and thrombectomy, but most allografts with arterial thrombosis are lost [13][14][15]. Renal vein thrombosis is often due to kinking of the renal vein, hypotension, acute rejection, or a hypercoagulable state.…”