A unique case of acute embolus in a renal transplant with salvage by catheter-directed thrombolysis

• Published in: Scottish medical journal Vol. 61; no. 2; p. 106
• Main Authors: McIlveen, E, Jackson, A, Bowie, J, Stirling, C, Downie, A, Kingsmore, D
• Format: Journal Article
• Language: English
• Published: Scotland 01.05.2016
• Subjects: Aged; Anticoagulants - administration & dosage; Catheterization, Peripheral - methods; Embolism - diagnostic imaging; Embolism - surgery; Female; Fibrinolytic Agents - administration & dosage; Heparin - administration & dosage; Humans; Kidney Transplantation; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - surgery; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; chemical thrombolysis; Renal transplant; embolus
• ISSN: 0036-9330
• DOI: 10.1177/0036933016635402

Acute renal transplant emboli can be disastrous and result in loss of the renal transplant. This case was successfully treated with thrombolysis. A 66-year-old female underwent a right-sided deceased heart-beating donor renal transplant. She had excellent transplant function but presented acutely three years later with pain in the transplanted kidney, an acute rise in serum creatinine and new onset atrial fibrillation. Bedside ultrasound scan demonstrated absent transplant perfusion. Emergency angiogram confirmed acute emboli in the transplant renal artery with some kidney perfusion. Thrombolysis with alteplase and anticoagulation with heparin was commenced. Serial imaging at 24 and 36 h demonstrated significant improvement in transplant perfusion. Following a period of supportive therapy, her transplant function recovered, although not to pre-morbid baseline levels. Consider acute embolus in a renal transplant patient with acute kidney injury, transplant tenderness and cardiac arrhythmia. Early thrombolysis may salvage renal transplants and good transplant function may be regained.