Successful Renal Transplantation in Small Children With a Completely Thrombosed Inferior Vena Cava

Am J Transplant. 2017 Jun;17(6):1670-1673. doi: 10.1111/ajt.14213. Epub 2017 Feb 28.

Abstract

In small children with end-stage renal disease, an adult-sized kidney transplant is the best option. However, in the face of a completely thrombosed inferior vena cava (IVC), such transplants can be challenging, given the difficulty of achieving adequate renal venous outflow and the risk of graft thrombosis. Using a new technique to anastomose the renal vein to the right hepatic vein/IVC junction, we successfully implanted an adult-sized graft in two small children (9.8 and 14 kg) who had end-stage renal disease and a completely thrombosed IVC. After mobilizing the right lobe of the liver and obtaining total vascular occlusion of the liver, we used a Fogarty catheter to dilate the retrohepatic IVC. In the right hepatic vein, we made a venotomy and extended it inferiorly onto the retrohepatic IVC. To that venotomy, we anastomosed the donor left renal vein, using continuous 7-0 Prolene sutures. Both patients attained excellent renal allograft function: One had a serum creatinine level of 0.30 mg/dL at 6 mo after transplant, and the other had a level of 0.29 mg/dL at 1 year. In these two small children with completely thrombosed IVC, our technique for transplanting an adult-sized kidney provided adequate venous outflow.

Keywords: clinical research/practice; complication: surgical/technical; kidney transplantation/nephrology; kidney transplantation: living donor.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Child, Preschool
  • Female
  • Humans
  • Infant, Newborn
  • Kidney Transplantation*
  • Living Donors
  • Male
  • Prognosis
  • Vena Cava, Inferior / surgery*
  • Venous Thrombosis / surgery*