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. 2016 May 23;2(6):e82.
doi: 10.1097/TXD.0000000000000592. eCollection 2016 Jun.

Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava

Seiichiro Shishido  1 , Takeshi Kawamura  1 , Yuko Hamasaki  1 , Yusuke Takahashi  1 , Yoshihiro Itabashi  1 , Masaki Muramatsu  1 , Hiroyuki Satoh  2 , Atsushi Aikawa  1
Affiliations

Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava

Seiichiro Shishido et al. Transplant Direct. .

Abstract

Background: Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow.

Methods: We conducted a retrospective study of 11 transplants in 9 patients with end-stage renal disease and thrombosed IVCs who received adult kidney allografts between 2000 and 2015. The mean age at transplantation was 7.5 ± 3.5 years. A pretransplant diagnosis of the IVC thrombosis was made in 7 patients by magnetic resonance imaging and computerized tomography, whereas there were 2 instances of intraoperative discovery of the IVC thrombosis.

Results: In the early cases, a kidney was placed intraperitoneally at the right iliac fossa with a venous anastomosis to the patent segment of the suprarenal IVC. After 2008, however, 6 adult-sized kidneys were subsequently placed in the left orthotopic position. Venous drainage was attained to the infrahepatic IVC (n = 3), left native renal vein (n = 2), and ascending lumbar vein (n = 1). Moreover, a venous bypass was created between the graft and the splenic vein in 2 children who showed high return pressure after the vessel was declamped. The mean glomerular filtration rate of the functioning 8 grafts 1 year posttransplant was 73.4 ± 20.4 mL/min per 1.73 m(2). Of note, 6 of the grafts have been functioning well, with a mean follow-up of 66 months. Both 1- and 5-year graft survival were 81.8%.

Conclusions: Transplantation into the left orthotopic position and the revascularization methods are an effective set of surgical techniques that could potentially be adopted as safe and reliable transplant approaches in children with IVC thrombosis.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
A, An MRI image showing complete obstruction of the infrarenal vena cava with an enlarged ascending lumbar vein (patient 10). B, An image of a 3D-CT performed 4 months after transplantation. The graft vein was pulled through between the superior mesenteric artery and aorta and was anastomosed to infrahepatic inferior vena cava.
FIGURE 2
FIGURE 2
A, An image of a 3D-CT in combination with venography showing complete obstruction of the inferior vena cava with an enlarged ascending lumbar vein and gonadal vein (patient 9). An expansion of the vertebral venous plexus was also detected. B, A graft was placed in the left orthotopic position with a graft venous anastomosis to the ascending lumbar vein. Moreover, a venous bypass was created between the graft vein and the splenic vein.
See this image and copyright information in PMC

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