Renal transplant in children with previous inferior vena cava thrombosis

Abstract

Our experience with renal transplantation in children with inferior vena cava thrombosis is presented in this study. Of the 238 children who have received renal transplants at our institution, four had IVC thrombosis (discovered during pretransplant evaluation: three patients; found at surgery: one patient). The pretransplant US evaluation diagnosis of IVC thrombosis in three patients was confirmed by transjugular retrograde cavography. There were no signs of hypercoagulability or IVC thrombosis symptoms prior to diagnosis in any patient. The graft was implanted in a left orthotopic position in three patients. Venous drainage was attained to the infrahepatic vena cava or native renal vein after ipsilateral nephrectomy. The renal artery of the graft was anastomosed to the aorta. In one patient, the graft was placed in the left iliac fossa. Patient and graft survival are 100%. Three grafts are functioning normally after a mean follow-up of 3.7 yr. The graft placed in the iliac fossa has moderate dysfunction due to high pressure venous outflow. Children with IVC thrombosis can be successfully transplanted orthotopically. Candidates with any suspicious-looking occlusion on ultrasound should be studied by retrograde venography to confirm diagnosis prior to transplantation.

Renal transplantation in children with thrombosis of the inferior vena cava requires careful assessment and planning

“…This is also strongly supported by other reports of renal transplantation with thrombosis of the IVC [2][3][4]. A corollary of this recommendation is that there also needs to be careful preoperative joint planning for the transplantation by the pediatric surgeon and nephrologist.…”

“…The articles cited above [1][2][3][4] account for 14 patients receiving kidney transplants and with preexisting IVC thrombosis. One patient that was described in two separate articles was counted as one, while another patient was included that had severe, but not complete, IVC obstruction [3].…”

“…There were three instances of intra-operative discovery of the IVC thrombosis [3,4], in two of which the planned living-donor transplantation had to be aborted. Since the evolvement of IVC thrombosis is usually a silent event, the question arises as to how far one should go to achieve adequate pretransplantation screening.…”

Successful renal transplantation in children in the presence of thrombosis of the inferior vena cava

“…Recent case reports in the literature have, however, suggested that successful transplantation may be possible in this technically challenging group of small children [5,6]. One such report proposes utilisation of small, deceaseddonor (DD) renal allografts (age range 0.7-6 years), speculating that such organs may enhance patient survival and provide either long-term renal function or a bridge to a larger renal allograft transplant at a later date [5].…”

“…One such report proposes utilisation of small, deceaseddonor (DD) renal allografts (age range 0.7-6 years), speculating that such organs may enhance patient survival and provide either long-term renal function or a bridge to a larger renal allograft transplant at a later date [5]. In contrast, a more recent study reports successful outcomes in four children who received adult-sized kidneys, two of which were from living-related donors (LRD) [6].…”