Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava

Shishido, Seiichiro; Kawamura, Takeshi; Hamasaki, Yuko; Takahashi, Yusuke; Itabashi, Yoshihiro; Muramatsu, Masaki; Satoh, Hiroyuki; Aikawa, Atsushi

doi:10.1097/txd.0000000000000592

Cited by 14 publications

(21 citation statements)

References 19 publications

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“…In this report, initial anastomosis in the two recipients was to the native left renal vein in one and ascending lumbar vein in the other. Pressures became too elevated upon reperfusion, and the splenic vein was chosen as a second site for the anastomosis to aid in redistributing the added pressure caused by the allograft drainage . In the setting of IVC occlusion with poor drainage, we needed a second site for drainage to reduce the risk of high venous pressures, allograft failure, and thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Larger kidneys may use more than 25% of circulating blood volume and result in higher outflow volumes in the pediatric recipient, putting these recipients at greater risk for complications. 8 Matching donor and recipient size requires meticulous attention for good outcomes in small pediatric kidney recipients. 7 Sarwal et al 7 reported superior long-term graft outcomes in small children who received adult size kidneys in the absence of acute tubular necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Pressures became too elevated upon reperfusion, and the splenic vein was chosen as a second site for the anastomosis to aid in redistributing the added pressure caused by the allograft drainage. 8 In the setting of IVC occlusion with poor drainage, we needed a second site for drainage to reduce the risk of high venous pressures, allograft failure, and thrombosis. We conclude that the SMV may serve as an alternative outflow tract and provides the vessel caliber needed to reduce the risks of complications such as thrombosis and torsion in kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

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Successful kidney transplantation in a small child with end‐stage renal disease due to angiotensin receptor blocker fetopathy and atretic inferior vena cava

Geha

Goss

et al. 2019

Pediatric Transplantation

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Kidney transplantation is the treatment of choice in pediatric patients with end‐stage renal disease. This population presents technical challenges particularly in those less than 20 kg due to anomalous anatomy, vascular access issues prior to transplantation, and a generally small size for age. Standard allograft outflow is usually achieved utilizing the iliac veins or IVC. When use of the iliocaval system is not feasible, alternative anastomosis must be considered. Herein, we report a case of a pediatric kidney transplantation where successful allograft outflow was achieved using the SMV when he was found to have an atretic IVC intraoperatively. In this setting, use of the portal system was required to achieve adequate allograft outflow. We created a donor iliac graft for added length to anastomose the renal vein with the SMV. In the setting of IVC occlusion with poor drainage, we utilized a patent vessel with larger caliber for outflow to reduce the risk of high venous pressures, allograft failure, venous rotation, and thrombosis. We conclude that the SMV may serve as an alternative outflow tract in the small pediatric patient and provides the vessel caliber needed to reduce the risks of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful kidney transplantation in a small child with end‐stage renal disease due to angiotensin receptor blocker fetopathy and atretic inferior vena cava

Geha

Goss

et al. 2019

Pediatric Transplantation

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“…A venous anastomosis should be considered for small children with a defect of the IVC. If the IVC cannot be used for venous anastomosis, the native renal vein, 5 the gonadal vein, [5][6][7] or the ascending lumbar vein 5 could be options. When these veins are too small to keep venous flow and to avoid high venous pressure, a splenic vein 5 after splenectomy, an inferior mesenteric vein, 10 a superior mesenteric vein, 11 or a portal vein 12 can be anastomosed with the renal vein.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] This procedure can allow clear discussion of the venous anastomosis site [5][6][7][8][9][10][11][12][13][14] and the necessity of a venous graft 5-12,13 before transplant surgery.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Aikawa

Muramatsu²,

Takahashi³

et al. 2018

Exp Clin Transplant

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During pediatric kidney transplant, surgical challenges occasionally occur. In particular, vascular anastomosis should be considered for children with small body weight < 12 kg, multiple renal arteries, vascular anomaly, and inferior vena cava occlusion. In pediatric patients, a living-donor renal graft is usually donated from a parent. Therefore, the renal artery and vein are too large to be anastomosed with the recipient's internal iliac artery and external iliac vein. In children who are > 12 kg, the renal artery and vein could be anastomosed with the external iliac artery and the external iliac vein. In children who are < 10 kg, the renal artery and vein should be anastomosed directly with the aorta and inferior vena cava. A pediatric transplant surgeon should consider arterial and venous anastomosis sites before transplant surgery. In small children with partial or total inferior vena cava occlusion, the venous anastomosis site should be evaluated. If the graft is placed on the left side, a venous graft must be used as a bridge between the renal vein and inferior vena cava. In 13 kidney transplants in children with inferior vena cava occlusion, 7 were on the left and 6 were on the right side. A patent segment of the inferior vena cava, the left original renal vein, an ascending lumbar vein, an azygos vein, the first graft renal vein, and a portal vein were used for venous anastomosis in 6, 2, 2, 1, 1 and 1 recipient, respectively. One child had graft loss due to renal vein thrombosis and one died of hemorrhage immediately posttransplant. Three had grafts with relatively long-term function, but these were lost due to chronic allograft nephropathy 100, 122, and 137 months posttransplant. However, the other 8 recipients have so far maintained graft function from 6 to 138 months since transplant. Key words: Living-donor renal transplant, Small body weight, Vascular anastomosis IntroductionFor kidney transplant, young children usually receive a living-related transplant from a parent donor. However, this adult renal allograft is transplanted in a small space in young children. In small children who are less than 10 kg body weight, we usually make a paramedian incision and the intraperitoneal approach is preferred, although recently the extraperitoneal approach has been also used in children who are less than 10 kg body weight. 1 When a renal allograft has double arteries, a conjoined and end-to-side anastomoses to one orifice are performed. Procedure times for multiple anastomoses are lengthy, leading to long ischemic time in the lower extremities and pelvic organs. In addition, a multiple arterial anastomosis to a direct aorta increases the risk of massive bleeding.In children with a thrombosed inferior vena cava (IVC), a pretransplant evaluation with three-dimensional computed tomographic (3D-CT) venography is important. [2][3][4] This procedure can allow clear discussion of the venous anastomosis site [5][6][7][8][9][10][11][12][13][14] and the necessity of a venous graft 5-12,13 before transplant sur...

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