A rare cause of iliocaval thrombosis in kidney transplantation

Renal vein thrombosis (RVT) has an incidence of 0.55% to 3.4% and accounts for as many as one-third of early allograft losses. Rarely, RVT may be a consequence of an extension of ipsilateral iliac vein thrombosis. We present a rare case of iliocaval thrombosis as a consequence of inferior vena cava compression by a large-for-size kidney transplant.

A 20-year-old woman with spina bifida and kidney failure received a living donor kidney from her 52-year-old father. On postoperative day 8, the patient had right lower quadrant abdominal pain associated with oliguria. Graft duplex ultrasonography examination revealed venous thrombosis arising in the right femoral vein and extending to the iliac vein. An urgent second laparotomy was performed, and the kidney was finally placed in the peritoneal cavity.

The eventuality of an inferior vena cava compression by a transplanted kidney should be considered in any recipient with sudden leg swelling and acute graft dysfunction. An early diagnosis and prompt intervention may reduce the progression to RVT and subsequent graft nephrectomy. When planning a kidney transplantation with a supposed size discrepancy between donor and recipient, positioning the kidney on the left side or in the peritoneal cavity may be preferred.