Management and Outcome After Early Renal Transplant Vein Thrombosis: A French Multicentre Observational Study of Real-Life Practice Over 24 Years

Early (<14 days) renal transplant vein thrombosis posttransplant (eRVTPT) is a rare but threatening complication. We aimed to assess eRVTPT management and the rate of functional renal transplantation. Of 11,172 adult patients who had undergone transplantation between 01/1997 and 12/2020 at 6 French centres, we identified 176 patients with eRVTPT (1.6%): 16 intraoperative (Group 1, G1) and 160 postoperative (Group 2, G2). All but one patient received surgical management. Patients in group G2 had at least one imaging test for diagnostic confirmation (N = 157, 98%). During the operative management of the G2 group, transplantectomy for graft necrosis was performed immediately in 59.1% of cases. In both groups, either of two techniques was preferred, namely, thrombectomy by renal venotomy or thrombectomy + venous anastomosis repair, with no difference in the functional graft rate (FGR) at hospital discharge (p = NS). The FGR was 62.5% in G1 and 8.1% in G2 (p < 0.001). Numerous complications occurred during the initial hospitalization: 38 patients had a postoperative infection (21.6%), 5 experienced haemorrhagic shock (2.8%), 29 exhibited a haematoma (16.5%), and 97 (55.1%) received a blood transfusion. Five patients died (2.8%). Our study confirms the very poor prognosis of early renal graft venous thrombosis. Graphical Abstract

[1]  L. Reis,et al.  Acute graft thrombosis in patients who underwent renal transplant and received anticoagulant or antiplatelet agents. A systematic review and meta-analysis. , 2022, American journal of clinical and experimental urology.

[2]  E. Thompson,et al.  Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis , 2021, Clinical transplantation.

[3]  F. Volberg,et al.  Contrast-enhanced ultrasound of transplant organs — liver and kidney — in children , 2021, Pediatric Radiology.

[4]  C. Lambert,et al.  Management of Immunosuppression After Kidney Transplant Failure: Effect on Patient Sensitization. , 2020, Transplantation proceedings.

[5]  C. Zuiani,et al.  Role for contrast-enhanced ultrasound in assessing complications after kidney transplant , 2020, World journal of radiology.

[6]  M. Struys,et al.  Ischemia and Reperfusion Injury in Kidney Transplantation: Relevant Mechanisms in Injury and Repair , 2020, Journal of clinical medicine.

[7]  S. Kulkarni,et al.  Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study. , 2019, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[8]  C. Menias,et al.  Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. , 2019, Radiographics : a review publication of the Radiological Society of North America, Inc.

[9]  S. Weinstein,et al.  Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow , 2018, Abdominal Radiology.

[10]  P. Kawano,et al.  A case report of venous thrombosis after kidney transplantation – We can save the graft? Time is the success factor , 2017, International journal of surgery case reports.

[11]  A. Halawa,et al.  Transplant Renal Vein Thrombosis. , 2017, Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation.

[12]  A. Ghoreifi,et al.  Immediate Vascular Complications After Kidney Transplant: Experience from 2100 Recipients. , 2016, Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation.

[13]  S. Sampaio,et al.  Late Allograft Renal Vein Thrombosis Treated With Anticoagulation Alone: A Case Report. , 2016, Transplantation proceedings.

[14]  M. Salvadori,et al.  Update on ischemia-reperfusion injury in kidney transplantation: Pathogenesis and treatment. , 2015, World journal of transplantation.

[15]  K. Salmela,et al.  Surgical complications following 1670 consecutive adult renal transplantations: a single center study , 2015, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[16]  C. Ponticelli Ischaemia-reperfusion injury: a major protagonist in kidney transplantation. , 2014, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[17]  S. Krishnaswamy,et al.  Successful thrombolysis of renal allograft venous thrombosis – A case report , 2014 .

[18]  O. Viklicky,et al.  Kidney transplant early venous complications managed by reperfusion and re-transplantation - salvage procedure. , 2014, Bratislavske lekarske listy.

[19]  H. Wyrley-Birch,et al.  Post-Operative 3-Dimensional Contrast-Enhanced Ultrasound (CEUS) Versus Tc99m-DTPA in the Detection of Post-Surgical Perfusion Defects in Kidney Transplants – Preliminary Findings , 2013, Ultraschall in der Medizin.

[20]  R. Latifi Surgical Decision-making Process: More Questions Than Answers , 2013, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[21]  Wendy Crebbin,et al.  Clinical decision making: how surgeons do it , 2013, ANZ journal of surgery.

[22]  E. Daugas,et al.  Acute renal infarction: a case series. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[23]  L. Rostaing,et al.  Donor-specific antibodies after ceasing immunosuppressive therapy, with or without an allograft nephrectomy. , 2012, Clinical journal of the American Society of Nephrology : CJASN.

[24]  T. Jørgensen,et al.  Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature , 2012, Journal of transplantation.

[25]  G. Grosso,et al.  Age is an important predictor of kidney transplantation outcome. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[26]  J. Cook Surgical complications , 2011, Dermatologic therapy.

[27]  P. Grzelak,et al.  Disturbances of kidney graft perfusion as indicators of acute renal vein thrombosis in contrast-enhanced ultrasonography. , 2011, Transplantation proceedings.

[28]  Rhona Flin,et al.  Surgeons' intraoperative decision making and risk management. , 2011, American journal of surgery.

[29]  D. Mandry,et al.  [Vascular complications following renal transplantation: diagnostic evaluation]. , 2011, Journal de radiologie.

[30]  A. Figueiredo,et al.  Surgical complications in 2000 renal transplants. , 2011, Transplantation proceedings.

[31]  R. Feld,et al.  Transplant renal vein thrombosis: role of preoperative and intraoperative Doppler sonography. , 2009, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[32]  J. Czerwiński,et al.  Complications of transplantation of kidneys from expanded-criteria donors. , 2009, Transplantation proceedings.

[33]  C. Ponticelli,et al.  Renal allograft thrombosis. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[34]  J. Pascual,et al.  Risk factors for early renal graft thrombosis: a case-controlled study in grafts from the same donor. , 2008, Transplantation proceedings.

[35]  C. H. Cockrell,et al.  Selective low-dose streptokinase infusion in the treatment of acute transplant renal vein thrombosis , 2007, CardioVascular and Interventional Radiology.

[36]  C. Thalhammer,et al.  Renal vein thrombosis after renal transplantation--early diagnosis by duplex sonography prevented fatal outcome. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[37]  M. Salifu,et al.  RENAL TRANSPLANTATION: AN UPDATE FOR THE GENERAL NEPHROLOGIST , 2005 .

[38]  M. Melamed,et al.  Combined Percutaneous Mechanical and Chemical Thrombectomy for Renal Vein Thrombosis in Kidney Transplant Recipients , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[39]  F. Delmonico,et al.  Expanded criteria donors for kidney transplantation , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[40]  S. Mulgaonkar,et al.  Hypercoagulable states in renal transplant candidates: impact of anticoagulation upon incidence of renal allograft thrombosis. , 2001, Transplantation.

[41]  M. Kessler,et al.  Successful surgical thrombectomy of renal allograft vein thrombosis in the early postoperative period. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[42]  C. Antoine,et al.  Successful endoluminal thrombo-aspiration of renal graft venous thrombosis , 2000, Transplant international : official journal of the European Society for Organ Transplantation.

[43]  J. Wetzels,et al.  Partial renal vein thrombosis in a kidney transplant: management by streptokinase and heparin. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[44]  J. Cohen,et al.  Acute renal allograft dysfunction in the setting of deep venous thrombosis: a case of successful urokinase thrombolysis and a review of the literature. , 1993, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[45]  P. Bretan,et al.  Noninvasive radiological diagnosis of renal vein thrombosis in renal transplantation. , 1991, The Journal of urology.