Successful Urgent Transplantation of an Adult Kidney into a Child with Inferior Vena Cava Thrombosis

Abstract

Poor venous drainage options following inferior vena cava (IVC) thrombosis have been considered to complicate or preclude renal transplantation of adult kidneys into pediatric patients. We describe urgent renal transplantation in a 5-year-old (15.3 kg) male with IVC thrombosis using an adult living donor. Preoperative magnetic resonance venography revealed a patent infrahepatic/suprarenal vena cava and portal system. In surgery, the right liver lobe was mobilized sufficiently to anastomose the graft renal vein to the native IVC at the confluence of the native left renal vein and proximal vena cava. Graft function has remained excellent with serum creatinine of 0.5 mg/dL at 36 months. IVC thrombosis need not preclude successful transplantation of adult-sized kidneys into children.

Renal Transplantation With Size-Matched End-to-End Venous Anastomosis in Children With Inferior Vena Cava Thrombosis

“…In addition to these, there are case series defined by Patel If the right kidney will be used in children with small abdominal volume, the renal vein may not reach to the VCI, particularly under the liver because adult-size graft volume is larger. Moreover, because the diameter of graft renal vein would be wide and the flow rate would be high, using adultsize kidneys should be considered contraindicated for transplantation [2]. In the present cases, small-size grafts that had been obtained from pediatric cadavers were used in the pediatric recipients who had VCI thrombosis and small intra-abdominal cavity.…”

“…It has been tried to overcome this situation, which is a relative contraindication, via some defined surgical procedures, which then have been published as case series. One of these methods is the anastomosis of renal vein to the subhepatic area after the liver has been metabolized in patients with intrahepatic VCI thrombosis, which was defined by Stevens et al based on a single case [2]. Orthotropic renal transplantation, which is performed as end-to-end anastomosis of renal veins following native nephrectomy, is another method defined by Martinez-Urretia et al based on 4 cases [3].…”

Chylous ascites complicating pediatric renal transplantation

“…IVC thrombosis is no longer considered a contra-indication to renal transplant, with successful use of alternatives, such as infrahepatic/suprarenal IVC, portal vein or inferior mesenteric vein, among others having been reported [12]. Anastomosis of the renal vein to the portal vein could potentially lead to venous congestion of the bowel with consequent lymphatic transudation.…”

Kidney transplantation in a patient with congenital vena cava and right vena iliaca communis hypoplasia

“…Reported cases of successful renal transplantation in patients with inferior vena cava (IVC) dysplasia are rare [4]. Alternative surgical procedures for venous anastomosis are anastomosis of the renal vein to the superior or inferior mesenteric vein, reconstruction of the IVC with an interposition graft or venous anastomosis to the portal vein [5–7]. We report a successful allogenous renal retransplantation in a 58‐year‐old Caucasian female patient.…”