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

Abstract

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.

Endovenous Iliocaval Revascularization for Transplant Kidney Salvage

“…11 These same treatment options were successfully applied in other cases reported in the literature, thus providing a good endovenous strategy for acute DVT after kidney transplantation. [11][12][13][14] The case report of Kim et al 15 about iliac vein stenosis as a complication of renal transplantation is the only one which is slightly comparable with our case. They describe a case of a patient presenting with painless lower limb edema and kidney dysfunction 16 years after transplantation based on stenosis of the right common iliac vein and kinking at the right common iliac artery bifurcation.…”

“…11 In all 4 patients, treatment consisted of catheter-directed thrombolysis, venous thrombectomy, balloon angioplasty, venous stenting, and lifelong warfarin. 11 These same treatment options were successfully applied in other cases reported in the literature, thus providing a good endovenous strategy for acute DVT after kidney transplantation. [11][12][13][14] The case report of Kim et al 15 about iliac vein stenosis as a complication of renal transplantation is the only one which is slightly comparable with our case.…”

External iliac vein to inferior vena cava bypass as an alternative management for external iliac vein stenosis and thrombosis in renal transplant recipients

“…Postoperative renal transplantation complications are usually divided into vascular complications, ureteric complications, lymphocele formation, and general surgical problems such as bleeding and wound infections 1. Vascular anastomosis is an essential part of the renal transplantation process, where in most cases, the allograft is anastomosed to the recipient’s iliac vessels 2. Vascular complications are probably the most anticipated and likely to cause sudden renal allograft loss 1.…”

The epidemiology of early deep vein thrombosis in kidney transplant recipients

“… 1 , 2 Overall, the incidence of deep vein thrombosis (DVT) among KTRs ranges from 4.6% to 12.5%, 3 – 5 with most DVT events occurring within 3 months of transplantation. 2 , 4 , 5 VTE has been reported to have negative effects on graft function, 6 graft survival 2 , 7 and patient survival 2 , 8 in KTRs.…”