Nontraditional sites for vascular anastomoses to enable kidney transplantation in patients with major systemic venous thromboses

Abstract

Successful renal transplantation requires low-pressure venous drainage to permit adequate outflow from the allograft. We report here a series of three patients in whom the inferior vena cava as well as bilateral iliac veins were thrombosed, making it necessary to explore less traditional vessels for venous drainage of the renal allograft. We utilized the splanchnic vasculature in two cases and the native left renal vein in another. The resulting atypical intra-abdominal locations of these allografts also presented difficulties for arterial anastomoses and for urinary drainage. Arterial conduits were utilized in two cases to facilitate anastomosis to the common iliac artery or the aorta, and in the third case, the splenic artery was used for arterial inflow. A traditional ureterocystostomy was technically feasible for only one patient. In another, ureteroureterostomy to the native ureter was performed, and in the third case, the creation of an ileal conduit was necessary. All three patients had antibodies to human leukocyte antigens and two required desensitization. All three kidneys had immediate graft function and continued to function at 1 year post-transplant. With a combination of planning, creativity, and persistence, patients with IVC thrombosis can enjoy the benefits of renal transplantation.

Renoportal Anastomosis During Liver Transplantation in Patients With Portal Vein Thrombosis

“…The drainage of the left kidney into the portal system following RPA did not impact long-term renal function compared to standard LT 53 . This is in line with the results following kidney transplantation with drainage of the graft into the portal vein (or one of its tributaries) in the case of thrombosis of the inferior vena cava.…”

Renal transplantation in the setting of aortic atresia: Utilizing hepatic artery inflow with donor vessel jump graft

“…In the first, the patient had significant infrarenal atherosclerotic disease and an obliterated infrarenal inferior vena cava due to prior trauma. 9 The second patient had infrarenal inferior vena cava thrombosis and was receiving an ABO incompatible organ, prompting concurrent splenectomy. 10 In the case series discussing thoracic aorta use, a prosthetic arterial bypass to the femoral artery was carried out due to major calcific disease within the iliac arteries for the four discussed patients.…”

Kidney Transplantation in Children with Thrombosed Inferior Caval Vein – Atypical Vascular Anastomoses

“…In the past, children with potentially compromised renal venous outflow were considered high-risk and unsuitable for kidney transplantation because of possible graft loss due to thrombosis [2]. Successful kidney transplantation requires low-pressure venous drainage to permit adequate outflow from the allograft; thus, kidney transplantation in the presence of IVC thrombosis remains a major challenge for transplant surgeons [6]. The selection of venous drainage in this situation should also include the possibility of arterial anastomosis, as well as urinary drainage.…”