Vascular Complications After Renal Transplant: A Single-Center Experience

• Published in: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation Vol. 15; no. Suppl 1; pp. 79 - 83
• Main Authors: Ayvazoglu Soy, Ebru H, Akdur, Aydincan, Kirnap, Mahir, Boyvat, Fatih, Moray, Gokhan, Haberal, Mehmet
• Format: Journal Article
• Language: English
• Published: Turkey 01.02.2017
• Subjects: Adolescent; Adult; Aged; Angiography; Child; Child, Preschool; Female; Humans; Incidence; Infant; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; Male; Middle Aged; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Turkey - epidemiology; Vascular Diseases - diagnostic imaging; Vascular Diseases - epidemiology; Vascular Diseases - surgery; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Young Adult
• ISSN: 2146-8427
• DOI: 10.6002/ect.mesot2016.O65

Despite surgical and medical advances, vascular complications are still among the major concerns after renal transplant, with a reported incidence of 3% to 15%. We evaluated the incidence and management of our transplant team 's vascular complications over 40 years. From November 1975 to the present, we have performed a total of 2594 renal transplant procedures. Of these, 1997 grafts (76%) were obtained from living donors, and 597 grafts (24%) were obtained from deceased donors. All renal transplant procedures, including those performed in pediatric patients, used the extraperitoneal approach to the contralateral iliac fossa. Revascularization was performed for all grafts. A single end-to-end internal iliac artery anastomosis was performed in 1082 patients (41.8%), an end-to-side external iliac artery anastomosis was performed in 1289 patients (49.7%), and an end-to-side common iliac artery anastomosis was performed in 66 patients (2.5%). In 157 procedures (6%), there were at least 2 renal arteries, and both internal iliac arteries or external iliac arteries were used for anastomosis. We observed 57 vascular complications (2.1%) in 54 renal transplant procedures. The most frequent complication was renal artery stenosis (n = 17; 0.6%). There were 8 instances of renal artery thrombosis (0.4%), 7 of renal artery kinking (0.3%), 5 of renal vein thrombosis (0.2%), 9 of renal vein kinking (0.5%), 3 of external iliac artery dissection (0.01%), 5 renal vein lacerations (0.2%), and 3 renal artery lacerations (0.01%). We performed urgent surgery for 41 vascular complications; 38 were managed successfully. Percutaneous interventional techniques were used successfully for 18 vascular complications. The vascular complication rate in our patients is lower than that reported in the literature. Surgical complications can be minimized with careful transplant technique and close follow-up, as early diagnosis is crucial to early management and successful treatment of complications.