Vascular complication in live related renal transplant: An experience of 1945 cases

Aneesh Srivastava, Jatinder Kumar, Sandeep Sharma, Abhishek, M S Ansari, Rakesh Kapoor, Aneesh Srivastava, Jatinder Kumar, Sandeep Sharma, Abhishek, M S Ansari, Rakesh Kapoor

Abstract

Introduction and objective: Among the surgical complications in renal transplantation, the vascular complications are probably most dreaded, dramatic, and likely to cause sudden loss of renal allograft. We present our experience and analysis of the outcome of such complications in a series of 1945 live related renal transplants.

Materials and methods: One thousand nine hundred and forty five consecutive live related renal transplants were evaluated retrospectively for vascular complications. Complications were recorded and analyzed for frequency, time of presentation, clinical presentation, and their management.

Results: The age of patients ranged from 6 to 56 years (mean = 42). Vascular complications were found in 25 patients (1.29%). Most common among these was transplant renal artery stenosis found in 11 (0.58%), followed by transplant reznal artery thrombosis in 9 (0.46%), renal vein thrombosis in 3 (0.15%), and aneurysm formation at arterial anastmosis in 2 (0.10%) patient. The time of presentation also varied amongst complications. All cases of arterial thrombosis had sudden onset anuria with minimal or no abdominal discomfort, while venous thrombosis presented as severe oliguria associated with intense graft site pain and tenderness. Management of cases with vascular thrombosis was done by immediate surgical exploration. Two patients of renal artery stenosis were managed with angioplasty and stent placement.

Conclusions: Major vascular complications are relatively uncommon after renal transplantation but still constitute an important cause of graft loss in early postoperative period. Aneurysm and vessel thrombosis usually require graft nephrectomy. Transplant renal artery stenosis is amenable to correction by endovascular techniques.

Keywords: Live related renal transplant; renal artery stenosis; renal artery thrombosis.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
MR angiogram showing sudden cut off in graft artery just distal to anastomosis site at external iliac artery
Figure 2
Figure 2
MR angiogram showing pseudoaneurysm in external iliac artery
Figure 3
Figure 3
MR angiogram showing stenosis at anastomosis site in internal iliac artery
Figure 4
Figure 4
Digital subtraction angiography (DSA) of the same patient
Figure 5
Figure 5
DSA after deployment of endovascular stent
Figure 6
Figure 6
Final DSA showing normal blood flow in graft artery

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Source: PubMed

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