Management and Outcome After Early Renal Transplant Vein Thrombosis: A French Multicentre Observational Study of Real-Life Practice Over 24 Years
Ludivine CambouC. MilletN. TerrierPaolo MalvezziM.-O. TimsitDany AnglicheauLionel BadetEmmanuel MorélonThomas PrudhommeNassim KamarAnne LejayPeggy PerrinCharlotte Uro-CosteBruno PereiraAnne Elisabeth HengCyril GarrousteLaurent Guy
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Abstract:
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.Keywords:
Nephrology
Renal vein thrombosis
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THROMBOSIS of the renal veins in infancy is an unusual occurrence, and is commonly attributed to dehydration or sepsis. Sometimes, however, it occurs without any apparent predisposing cause, and under these circumstances it has been referred to as primary renal-vein thrombosis.1 The 2 patients discussed below were the infants of diabetic mothers. A review of the literature reveals 2 other infants with renal-vein thrombosis, also the offspring of diabetic mothers.2 , 3 In addition, there are reports of several infants weighing over 4 kg. with thrombosis of the renal veins in the newborn period in the absence of dehydration or sepsis.4 , 5 Usually, . . .
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In clinical practice, thrombosis of the renal vein is rare, but, when encountered, it requires prompt urologic evaluation. The diagnosis has been established most frequently at operation or autopsy, and it was not until 1942 that the first preoperative diagnosis of renal vein thrombosis was confirmed at operation by Campbell.1With the modern facilities now available to the urologist, the correct diagnosis should be easier to make. Two instances of thrombosis of the renal veins are presented here to reemphasize the importance of a correct preoperative diagnosis. Thrombosis of the renal vein occurring in infancy is usually of the primary type; the thrombotic process arises in the renal vein or in its intrarenal tributaries. In 1945, Abeshouse2reviewed 228 cases of renal vein thrombosis and found that 98 of those cases were in children less than one year old and, that, of this total, 90 occurred in infants
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Abstract Renal vein thrombosis and adrenal hemorrhage can both be encountered in the neonatal period and they may occur at the same time. Inferior vena cava thrombosis can complicate some cases. These diseases can be easily diagnosed by means of ultrasound. The authors present 4 cases in which newborns were affected by renal vein thrombosis associated with adrenal hemorrhage and caval thrombosis, evaluated by means of ultrasound. The echographic aspect of renal, adrenal and caval involvement is described. © 1993 John Wiley & Sons, Inc.
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The substantial morbidity associated with renal vein thrombosis dictates early diagnosis and therapy. While acute renal vein thrombosis may present with symptoms and radiographic features suggestive of venous thrombosis the findings in chronic renal vein thrombosis the findings in chronic renal vein thrombosis are often non-specific. A case of acute renal vein thrombosis is reported in which thrombus in the inferior vena cava was visualized with B-scan ultrasonography. Since nearly 50% of the reported cases of renal vein thrombosis are associated with thrombosis of the inferior vena cava, B-scan ultrasonography may provide a simple method of early diagnosis.
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To report on three patients with partial graft renal vein thrombosis diagnosed by ultrasound.The vascular complications diagnosed by ultrasound in 400 transplants performed from 1995-1998 were reviewed.Three patients with partial graft renal vein thrombosis were found. Two patients were treated with anticoagulant therapy. No thrombosis could be detected in all three patients on subsequent US control evaluation.Unlike complete thrombosis, partial graft renal vein thrombosis presents late, without significant clinical features and can be managed conservatively.
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Objective To investigate the specificity of ultrasound in the diagnosis of renal allograft vascular thrombosis.Methods The ultrasound data of 22 patients,from out of 1517 renal transplants from Jan.1996 to Mar.2011 in our hospitals,with renal allograft vascular thrombosis diagnosed by ultrasound within 1 year after renal allograft transplantation were retrospectively studied.Results Among the 22 patients,4 patients were diagnosed as renal allograft artery thrombosis by ultrasound,of which 3 were confirmed by surgery and pathology but the other one was misdiagnosed.One patient was diagnosed as inferior renal artery thrombosis and confirmed by surgery thereafter.Four of 8 ultrasound-diagnosed renal vein thrombosis were confirmed,but 2 of the other 4 patients were proved to be acute rejection by pathology,while the other 2 were proved as misdiagnosis by surgery or other clinical manifestation.As for 9 patients of ultrasound-diagnosed renal vein partial thrombosis,1 and 3 patients were proved to be misdiagnosis by surgery and clinical manifestation respectively,while the other 5 patients showed no sign of thrombosis on ultrasonography after thrombolytic therapy.Conclusion Ultrasound has a high specificity to diagnose renal allograft artery thrombosis,while a low specificity to diagnose renal allograft vein thrombosis.
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Renal vein thrombosis was noted to occur in six burned children at our institution over the last 20 years. One patient was diagnosed at post-mortem and two were diagnosed within 24 hours prior to their deaths. Three were diagnosed and successfully treated by anticoagulation with heparin. Renal vein thrombosis is a complication occurring in severely burned children that can be successfully treated if diagnosed early.
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