A case report of venous thrombosis after kidney transplantation – We can save the graft? Time is the success factor

Kawano, Paulo Roberto; Yamamoto, Hamilto Akihissa; Gerra, Rodrigo; Garcia, Patrícia Carvalho; Contti, Mariana Moraes; Nga, Hong Si; Takase, Henrique Mochida; Bravin, Ariane Moyses; Andrade, Luís Gustavo Modelli de

doi:10.1016/j.ijscr.2017.04.022

Cited by 10 publications

(13 citation statements)

References 12 publications

(26 reference statements)

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“…Until the present study, no studies evaluating the frailty score as a specific predictor of surgical complications after KTx have been identified. In general, the frequency of urological, vascular, and general surgical complications in the studied sample was in agreement with the literature [3,4,[6][7][8][9][10]. Urinary leak was the most frequent complication, accounting for 8.0% of the total.…”

Section: Discussionsupporting

confidence: 90%

“…In turn, vascular complications, observed in 3 to 15% of cases, tend to have less favorable outcomes. With the exception of lymphocele and renal artery stenosis, pseudoaneurysms and vascular thromboses (of either the renal artery or vein) typically progress to graft loss, regardless of the diagnosis and/or applied treatment [8][9][10]. Other complications of KTx can be classified as general complications, and these involve mainly surgical wound dehiscence/infection [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Frailty predicts surgical complications after kidney transplantation. A propensity score matched study

et al. 2020

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Background and objective Surgical complications after kidney transplantation can lead to catastrophic outcomes. Frailty has been associated with important kidney transplantation outcomes; however, there are no studies assessing this measure of physiological reserve as a specific predictor of surgical complications in this population. Such an assessment was, therefore, the objective of the present study. Methods A total of 87 individuals aged � 18 years who underwent kidney transplantation between March 2017 and March 2018 were included. At the time of admission for kidney transplantation, demographic, clinical, and kidney transplantation data were collected, and the frailty score was calculated according to Fried et al., which comprises five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed. Urological, vascular, and general surgical complications were assessed three months later, or until graft loss or death. The propensity score was used to achieve a better homogeneity of the sample, and new analyses were performed in this new, balanced sample. Results Of the 87 individuals included, 30 (34.5%) had surgical complications. After propensity score matching, the risk of surgical complications was significantly higher among the frail individuals (RR 2.14; 95% CI 1.01-4.54; p = 0.035); specifically, the risk of noninfectious

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Frailty predicts surgical complications after kidney transplantation. A propensity score matched study

et al. 2020

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“…Iliofemoral and iliocaval thromboses after kidney transplantation that required surgical intervention are described in the literature 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22. Patients presented anytime from 1 day to 16 years postoperatively, and presenting symptoms were LE edema and AKI.…”

Section: Discussionmentioning

confidence: 99%

Iliofemoral deep venous thrombosis in kidney transplant patients can cause graft dysfunction

Khalifeh

Reif

Tolayamat

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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We present a series of kidney transplant dysfunction secondary to lower extremity deep venous thrombosis (DVT). A 70-year-old man underwent living unrelated kidney transplantation and presented 2 months postoperatively with acute kidney injury (AKI) secondary to external iliac vein thrombosis. Graft function improved after endovascular intervention. A 43-year-old man underwent living unrelated kidney transplantation and presented 3 years postoperatively with AKI secondary to external iliac vein thrombosis. Graft function recovered after thrombolysis. A 42-year-old woman underwent simultaneous pancreas and kidney transplantation. Four weeks postoperatively, she had AKI secondary to common femoral vein DVT. Her graft function improved after common iliac vein stenting. A 67-year-old man underwent living unrelated kidney transplantation and presented a week later with lower extremity DVT and AKI. His graft function improved with anticoagulation. Iliofemoral DVT can cause allograft dysfunction. The cause may be multifactorial. Endovascular intervention is safe and feasible when anticoagulation fails.

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“…Renal vein thrombosis occurs mainly due to systemic hypercoagulable states, the most common being nephrotic syndrome with urinary losses of anticoagulant proteins [4]. Other prothrombotic aetiologies of renal vein thrombosis include hyperhomocysteinemia, antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria, renal cell carcinoma or other active malignancy, renal transplantation, trauma, postpartum, oral contraceptive use and sepsis syndrome [5][6][7][8][9][10]. Only seven previous cases of RVT complicating acute pyelonephritis or renal and perirenal abscesses have been described [1].…”

Section: Discussionmentioning

confidence: 99%

Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli

et al. 2018

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Acute pyelonephritis might be complicated by the formation of renal and perirenal abscesses and very rarely by renal vein thrombosis, which is a life-threatening condition. The main causative agents of acute pyelonephritis are enterobacteriaceae with the incidence of extended-spectrum beta-lactamase (ESBL)-producing strains increasing worldwide. We present the case of a 71-year-old Greek man with history of diabetes mellitus and recent hospitalization, who suffered from severe pyelonephritis with renal abscesses formation and associated bacteraemia caused by ESBL-producing Escherichia coli, complicated by extensive thrombosis of the ipsilateral renal vein and its branches, protruding also in the inferior venal cava. Our patient was effectively treated with anticoagulants and targeted antibiotic therapy, respectively, consisted of low molecular weight heparin transitioned to oral acenocoumarol for 3 months and 2-week course of intravenous meropenem followed by oral fosfomycin for additional 3 weeks as quidded by clinical and computed tomographic follow-up. In conclusion, in complicated urinary infections, caused by ESBL-producing enterobacteriaceae, oral fosfomycin might represent an effective option for step-down therapy of carbapenems, allowing the shortness of the duration of patient's hospitalization and carbapenem use.

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A case report of venous thrombosis after kidney transplantation – We can save the graft? Time is the success factor

Abstract: HighlightsKidney graft vein thrombosis is a rare surgical complication.The reports of graft rescue are scarce.The diagnosis of vascular complications should be done as early as possible.The fundamental to the success is the time of diagnosis to intervention.

Cited by 10 publications

References 12 publications

Frailty predicts surgical complications after kidney transplantation. A propensity score matched study

Frailty predicts surgical complications after kidney transplantation. A propensity score matched study

Iliofemoral deep venous thrombosis in kidney transplant patients can cause graft dysfunction

Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli

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