A Case Series of Asymptomatic Hemodialysis Catheter-Related Right Atrial Thrombi That Are Incidentally Detected Prior to Kidney Transplantation

• Published in: Transplantation proceedings Vol. 50; no. 10; pp. 3172 - 3180
• Main Authors: Jeung, S., Kang, S.-M., Seo, Y., Yu, H., Baek, C.H., Kim, H., Yang, W.S., Park, S.-K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Adult; Catheters, Indwelling - adverse effects; Female; Heart Diseases - etiology; Humans; Incidental Findings; Kidney Transplantation; Male; Middle Aged; Renal Dialysis - adverse effects; Retrospective Studies; Risk Factors; Seoul; Thromboembolism - etiology; Young Adult; Seoul
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.08.026

A hemodialysis (HD) catheter-related right atrial thrombus (RAT) is rarely encountered prior to kidney transplantation (KT) but necessitates a decision about whether to anticoagulate and/or delay the surgery. There is controversy surrounding the clinical implications of a RAT in this situation. It is sometimes considered fatal but other opinions consider it to be benign, especially when incidentally detected. We reviewed the clinical characteristics, management, and outcomes of a patient series with HD catheter-related RAT detected prior to KT and speculated on its clinical significance. Among 3677 cases of KT performed on 3607 patients between January 1997 and September 2015 in our single tertiary center, 11 cases of HD catheter-related RAT detected on transthoracic echocardiography (TTE) prior to KT were included for analysis. The average maximal diameter of the RAT was 23.2 ± 16.3 (SD in mm) and 9 (81.8%) of these 11 patients had no symptoms associated with the RAT. Four patients (36.3%) had their catheters replaced, 5 patients (45.5%) had their catheters removed, and the catheters were maintained in the remaining 2 patients (18.2%). Six patients (54.5%) were anticoagulated with either heparin or warfarin. However all 11 patients had a successful KT suggesting that a HD catheter-related RAT incidentally detected prior to this surgery may not be as serious as previously considered and should not be a reason for delaying the transplantation. •A hemodialysis catheter-related right atrial thrombus (RAT) is rarely encountered prior to kidney transplantation.•There is controversy surrounding the clinical implications of a RAT in this situation.•A hemodialysis catheter-related RAT incidentally detected prior to kidney transplantation appears to be benign.