Vascular complications after pediatric kidney transplantation

Vascular complications, especially those including the renal vein, remain a major cause of lost graft.

To evaluate retrospectively the incidence and management of vascular complications after pediatric renal transplantation and to assess possible risk factors and their effects on patient and graft.

A total of 82 consecutive renal transplants were performed in 79 patients at a single institution. The diagnosis of vascular complications was suspected in the presence of suggestive symptoms and confirmed by Doppler ultrasound and if necessary by a computed tomographic angiography. Urgent exploration was performed in all suspected cases.

There were seven vascular complications (8,5%), including renal vein thrombosis in four patients, renal artery stenosis in one, and sural thrombophlebitis in two. The thrombosis of the graft vein which is the main complication occurred at mean 24 hours after renal transplantation. All these patients needed transplant nephrectomy after thrombosis event. In the remaining cases, the outcome was favorable even for the patient with transplant renal artery stenosis.

Vascular complications are common and serious events affecting patient and graft survivals. A perfect surgical technique and rigorous radiological monitoring may result in decreased incidence and severity of these complications.