Successful Fibrinolysis Following Thrombosis in a Grafted Kidney Artery

A 25 year old man was admitted to the transplant unit for an acute kidney graft pain which occured 20 hours before associated with oliguria. The chronic renal failure was due to reflux nephropathy. He underwent a kidney graft in November 1988. 2 kidney rejection episodes occured 10 days and 1 month after transplantation with a favorable out come. Baseline creatinemia stabilized around 150 micromol/L. Vascular graft thrill was noticed in January 1990. Systolodiastolic hypertension occured in February 1992, worsening progressively, with an impairement of the graft function. Angiography confirmed a slightly tight and stretched anastomotic and post anastomotic stenosis of the transplant artery. Transluminal angioplasty was performed with good inital results on hypertension and renal function. The thrill and hypertension reapered 10 months later. A new endoluminal dilatation was performed. Hypertension persisted but stenosis was non significant. Hypertension required Nifedipin 40 mg/day and Atenolol 50 mg/day. Creatininemia stabilized around 120 micromol/l. He was admitted in March 1995 for an acute graft pain and anuria. Angiography revealed complete thrombosis of the transplant artery. In situ fibrinolysis was performed with Recombinant Human Tissue-type Plasminogen Activator (Actilyse*). An in situ bolus of 10 mg was performed followed by an infusion of 40 mg for 45 mn. Total infusion was 1mg/kg. Continuous infusion of Heparin was started 12 hours after. An angiography performed 12 hours later confirmed the total desobstruction of the artery. Renal scintigraphy using Tc Mag 3 as tracer showed a good perfusion of the upper pole. He recovered diuresis after 3 days and satisfactory renal function after 3 weeks.