Successful salvage of renal allograft after renal vein thrombosis with endovascular intervention

Background: Renal vein thrombosis after renal allograft transplant is a potentially devastating occurrence leading to loss of the graft in the majority of cases. Late discovery of this finding can limit options for treatment and graft salvage. We report an early discovery of post-operative renal graft vein thrombosis, and management with endovascular techniques resulting in successful salvage of a deceased donor renal allograft. Case Report: The patient was a 42 year old male 1 week removed from a left deceased donor transplant re-admitted with hypotension, and left sided abdominal pain. Transplant arterial/venous duplex revealed increased resistance indices (RI) followed by a non-contrasted CT scan suggestive of acute thrombus in the allograft renal vein. Endovascular techniques along with thrombolytic therapy were able to salvage the graft in an expedient manner without open revision of the anastomosis. Conclusions: Renal vein thrombosis (RVT) is reported to occur in 0.6–3.4% of renal transplants, accounting for up to 33% of early graft loss with a median time to presentation of 8 days. A strong degree of suspicion is required in order to diagnosis renal vein thrombosis in the post-operative period. The initial radiologic diagnostic modality of choice is echocolordoppler which provides an 88% sensitive and 85% specific modality for the detection of graft thrombosis. The findings of an increased RI prompted the completion of the CT scan which confirmed the diagnosis. We were then able to involve the interventional radiology team for prompt endovascular treatment of the thrombosis and salvage of the renal transplant.