Vascular complications after pediatric kidney transplantation

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Published May 9, 2011
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Vol. 89 No. 5 (2011): Issue May 2011

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Tahar Gargah
Kamel Abidi
Hatem Rajhi
Taeb Ben Abdallah
Mohamed Chebil
Mohamed Rachid Lakhoua

Abstract

Background: Vascular complications, especially those including the renal vein, remain a major cause of lost graft.
Aims: To evaluate retrospectively the incidence and management of vascular complications after pediatric renal transplantation and to assess possible risk factors and their effects on patient and graft.
Methods:Atotal of 82 consecutive renal transplants were performed in 79 patients at a single institution. The diagnosis of vascular complications was suspected in the presence of suggestive symptoms and confirmed by Doppler ultrasound and if necessary by a computed tomographic angiography. Urgent exploration was performed in all suspected cases.
Results: There were seven vascular complications (8,5%), including renal vein thrombosis in four patients, renal artery stenosis in one, and sural thrombophlebitis in two. The thrombosis of the graft vein which is the main complication occurred at mean 24 hours after renal transplantation. All these patients needed transplant nephrectomy after thrombosis event. In the remaining cases, the outcome was favorable even for the patient with transplant renal artery stenosis.
Conclusions: Vascular complications are common and serious events affecting patient and graft survivals. A perfect surgical technique and rigorous radiological monitoring may result in decreased incidence and severity of these complications.

Keywords:

Child, Renal transplantation, Vein thrombosis, Artery stenosis

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References

  1. Sinha R, Saad A, Marks SD. Prevalence and complications of chronic kidney disease in paediatric renal transplantation: a K/DOQI perspective. Nephrol Dial Transplant 2010 ; 25 :1313- 20.
  2. Sanz DV, Ramos L, frutos B, et al. Vascular complications in pediatric renal transplant: echographic diagnosis. An Esp Pediatr 1999 ; 50:263-8.
  3. El Atat R, Derouiche A, Guellouz S , Gargah T , Lakhoua R , Chebil M. Surgical complications in pediatric and adolescent renal transplantation. Saudi J Kidney Dis Transpl 2010 ;21 : 251-7.
  4. Osman Y, Shokeir A, Ali-El-Dein B, et al .Vascular Complications After Live Donor Renal Transplantation: Study of Risk Factors and Effects on Graft and Patient Survival. J Urol 2003;169:859-62.
  5. Bakir, N., Sluiter, W. J., Ploeg, R. J., van Son, W. J. and Tegzess, A. M.: Primary renal graft thrombosis. Nephrol Dial Transplant, 1996; 11: 140- 3.
  6. Dimitroulis D, Bokos J, Zavos G, et al. Vascular Complications in Renal Transplantation: A Single-Center Experience in 1367 Renal Transplantations and Review of the Literature. Transplant Proc 2009 ; 41 : 1609-14.
  7. Fathi T, Samhan M, Gawish A, Donia F, Al-Mousawi M. Renal allograft venous thrombosis is salvageable. Transplant Proc 2007; 39: 1120-21.
  8. Lieburg V, Jong JW, Hoitsma AJ, Buskens M, Schröder H, Monnens H. Renal transplant thrombosis in children. J Pediatr Surg 1995;130: 615-19.
  9. Chiu AS, Landsberg DN: Successful treatment of acute transplant renal vein thrombosis with selective streptokinase infusion. Transplant Proc 1991; 23:2297-8.
  10. Waltzer WC, Turner S, Frohnert P, Rapaport FT. Etiology and pathogenesis of hypertension following renal transplantation. Nephron 1986 ; 42:102-9.
  11. Fontaine E, Beurton D, Barthelemy Y, Quentel P, Cukler J, Broyer M. Renal artery stenosis following pediatric renal transplantation. Transplant Proc 1994; 26:293-4.
  12. Wong W, Fynn SP, Higgins RM, et al. Transplant renal artery stenosis in 77 patients: does it have an immunological cause? Transplantation 1996; 61:215-19.
  13. Sheldon CA, Churchill BM, Khoury AE, McLorie GA. Complications of surgical significance in pediatric renal transplantation. J Pediatr Surg 2001; 4:485-9.
  14. Fauchald P, Vatne K, Paulsen D, et al. Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis. Nephrol Dial Transplant 1992; 7:256-9.