Renal transplantation
Complication: Technical
Vascular Complications in Renal Transplantation: A Single-Center Experience in 1367 Renal Transplantations and Review of the Literature

https://doi.org/10.1016/j.transproceed.2009.02.077Get rights and content

Abstract

Renal transplantation is the treatment of choice for end-stage renal disease. Vascular complications in renal transplantation are not uncommon and may often lead to allograft loss. The most common vascular complications are transplant renal artery stenosis, transplant renal artery thrombosis, transplant renal vein thrombosis, biopsy-induced vascular injuries, pseudoaneurysm formation, and hematomas. Transplant renal artery and vein thrombosis have an early onset and a dramatic clinical manifestation and usually lead to allograft loss. In contrast, transplant renal artery stenosis has better treatment possibilities, whereas the rest do not occur so often. In our institution, 1367 renal transplantations were performed from September 1980 to April 2005. During this period, we encountered 38 major vascular complications leading to graft loss and 19 transplant renal artery stenoses with successful treatment in the majority of cases. According to these data, we can conclude that renal transplantation is a safe therapeutic procedure for renal failure.

Section snippets

Transplant Renal Artery Stenosis

Transplant renal artery stenosis (TRAS), first reported in 1966, still represents one of the most critical complications potentially leading to renal graft dysfunction, posttransplant hypertension, and graft loss.6 It is considered the most common vascular complication (75%) in renal transplantation7 with a prevalence ranging from 1% to 23%.8, 9, 10 The variability of relevant epidemiological data reflects different approaches regarding the definition and the time of diagnosis of this

Transplant Renal Artery Thrombosis

Transplant renal artery thrombosis (TRAT) is a rare complication with a reported prevalence of 0.5% to 3.5%20; however, TRAT represents the major cause of graft loss in the early posttransplantation period. The clinical manifestations of this complication are acute reduction of urine output and elevation of renal function tests, often resulting in graft loss. The clinical presentation is milder and the outcome better when the thrombosis spares the renal artery trunk and affects only the smaller

Transplant Renal Vein Thrombosis

Transplant renal vein thrombosis (TRVT) is a dramatic, early vascular complication following renal transplantation, with a reported prevalence of 0.5% to 4%. Although a rare complication, it remains one of the most important causes of graft loss during the first month posttransplant.25 The acute onset of this condition includes pain, swelling of the renal graft, and ipsilateral lower extremity as well as low-grade fever.

The etiology of this complication is often multifactorial, including two

Biopsy-Induced Vascular Injuries

Arteriovenous fistulae and intrarenal pseudoaneurysms are the two most common types of vascular injuries resulting from percutaneous needle biopsy, occurring in 1% to 18% of renal allograft biopsies.28 An arteriovenous fistula forms when adjacent arterial and venous branches are lacerated simultaneously; a pseudoaneurysm occurs when only an arterial branch is lacerated. These vascular complications are easily detected with color Doppler flow and duplex Doppler US. Characteristic US findings in

A Single-Center Experience in 1367 Renal Transplantations

We have retrospectively analyzed our experience in 1367 renal transplantations from September 1980 to April 2005 with regard to vascular complications.

Patients and Methods

Among 1367 transplantations, 596 (43.6%) were from cadaveric and 771 (56.4%) from living related sources. Renal transplant vessels were anastomosed in an end-to-side fashion to the external iliac vessels of the recipients in virtually all cases, except only a few cases wherein we selected the common or internal iliac vessels. In most cases of cadaveric renal grafts, an aortic patch from the donor was also harvested and used at the site of the arterial anastomosis. We employed Lich-Gregoire

Results

In our series, vascular complications after renal transplantation (n = 57, 4.2%) were divided in two main categories: major vascular complications resulting in rapid graft loss (category I), and late-onset complications with a better treatment (category II), including virtually all renal transplant artery stenosis. Table 1 summarizes the rates of vascular complications following renal transplantation in our center.

Overall, we encountered 38 major vascular complications leading to allograft loss

Discussion

In summary, we have concluded that renal transplantation is the treatment of choice for ESRD. However, it carried a low (but clinically significant) risk for vascular complications that can lead to allograft loss. Alert, prompt evaluation by routine or emergency Doppler US examination and selective renal transplant angiography are required for graft preservation. Moreover, standardization of surgical techniques (ie, arterial and venous anastomoses) and advances in interventional radiology (PTA

References (37)

  • G. Zavos et al.

    Endovascular repair as first-choice treatment of iliac pseudoaneurysms following renal transplantation

    Transplant Proc

    (2005)
  • A. Carrel

    La technique operatoire des anastomoses vasculaires et la transplantation des visceres

    Lyon Med

    (1902)
  • P.D. Moore

    Give and Take: The Development of Tissue Transplantation

    (1964)
  • J.P. Merrill et al.

    Successful homotransplantations of the human kidney between identical twins

    JAMA

    (1956)
  • A.J. Kostakis et al.

    Toxic effects in the use of cyclosporine A in alcoholic solution as an immunosuppressant of rat heart allografts

    IRCS Med Sci

    (1977)
  • A.J. Kostakis et al.

    Prolongation of rat heart allograft survival by cyclosporin A

    IRCS Med Sci

    (1977)
  • Case records of the Massachusetts General HospitalCase 43-1966

    N Engl J Med

    (1966)
  • L.G. Aguera Fernandez et al.

    Vascular complications in 237 recipients of renal transplant from cadaver

    Actas Urol Esp

    (1992)
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