Immediate re‐transplantation following early kidney transplant thrombosis

Abstract

Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.

Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences

“…The association of higher donor age and recipient past history of venous thrombosis and DCD/ECD donor type in our univariate analysis with EGL is not surprising as these factors have been associated with graft thrombosis and worse long-term outcome (10,18,19). The increased EGL among DCD and ECD transplants in our series was due to a higher incidence of PNF and acute vascular occlusions.…”

“…The increased EGL among DCD and ECD transplants in our series was due to a higher incidence of PNF and acute vascular occlusions. The increased incidence of PNF in DCD kidneys may be attributable to warm ischemic injury in the donor; preliminary results in animal models suggest that DCD kidneys are more vulnerable to ischemia reperfusion injury (19,20).…”

Anti-Human Leukocyte Antigen Immunization After Early Allograft Nephrectomy

“…Recently, Phelan et al (17) reported their experience in performing a kidney retransplantation only a few days after a kidney-transplant thrombosis. Nine patients, who experienced early primary-graft thrombosis (initial transplant functioned for a mean of 1.67 days, range: 0Y7 days), underwent a subsequent transplantation within 2 weeks (0Y12 days) after the first transplant.…”

Mean Platelet Volume as a Potential Predictor of Renovascular Thrombosis After Renal Transplant

“…12 Transplant renal artery/vein thrombosis generally occurs during the first 2 postoperative weeks and is reported in up to 6% of kidney transplants. 13,14 In pediatric kidney transplant, graft loss due to thrombosis is a major problem. 15 According to the data from the North American Pediatric Renal Transplant Cooperative Study, vascular thrombosis accounts for 11.6% of graft losses in pediatric renal transplant.…”