Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature

Abstract

Renal graft survival has improved over the past years, mainly owing to better immunosuppression. Vascular thrombosis, though rare, therefore accounts for up to one third of early graft loss. We assess current literature on transplantation, identify thrombosis risk factors, and discuss means of avoiding thrombotic events and saving thrombosed grafts. The incidence of arterial thrombosis was reported to 0.2–7.5% and venous thrombosis 0.1–8.2%, with the highest incidence among children and infants, and the lowest in living donor reports. The most significant risk factors for developing thrombosis were donor-age below 6 or above 60 years, or recipient-age below 5-6 years, per- or postoperative hemodynamic instability, peritoneal dialysis, diabetic nephropathy, a history of thrombosis, deceased donor, or >24 hours cold ischemia. Multiple arteries were not a risk factor, and a right kidney graft was most often reported not to be. Given the thrombosed kidney graft is diagnosed in time, salvage is possible by urgent reoperation and thrombectomy. Despite meticulous attentions to reduce thrombotic risk factors, thrombosis cannot be entirely prevented and means to an early detection of this complication is desirable in order to save the kidneys through prompt reoperation. Microdialysis may be a new tool for this.

Association of Early Kidney Allograft Failure with Preformed IgA Antibodies to β 2-Glycoprotein I

“…Identification of risk factors for graft thrombosis may reduce early renal graft loss. 55 If our findings are corroborated, anticoagulation early after transplantation might be recommended in patients positive for IgA aB2GPI antibodies. Prospective and multicenter studies with more patients to show the usefulness of IgA aB2GPI antibodies as an early transplant failure biomarker are mandatory.…”

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“…The introduction of the Carrel patch vascular technique by Alexis Carrel in 1902 is considered among the most important developments in transplant surgery. 4 In Turkey, the first livingdonor kidney transplant was performed by Haberal and his team on November 3, 1975. Since then, Haberal has described different vascular anastomosis techniques.…”

“…The North American Pediatric Renal Transplant Cooperative Study cohort, with data collected from 1996 to 2001, lists thrombosis as the most common cause of early graft loss. 4 The complication of RAT usually occurs soon after the transplant procedure. It is destructive, usually resulting in graft loss, and its incidence is reportedly either 0.2% to 7.5% or 0.5% to 3.5%.…”

“…The incidence of RVT ranges from 0.1% to 8.2%, and it usually causes early graft loss. 4,10 The clinical presentations of this condition are sudden oliguria or anuria accompanied by pain, hematuria, and life-threatening hemorrhage due to graft rupture. Renal Doppler US confirms an increase in renal volume and absence of venous flow.…”

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

“…Deceased donor is a significant risk factor for developing renal allograft thrombosis along with donor age <6 or >60 years, recipient age <5-6 or >50 years, hemodynamic instability, peritoneal dialysis, recipient vessel atherosclerosis, diabetic nephropathy, a history of thrombosis, and DGF (24)(25)(26). Causing irreversible acute tubular necrosis, thrombotic complications are related with early graft failure (25,27).…”