Long-Term Outcomes of Kidney Transplantation With Inferior Vena Cava Outflow: A Single Center Experience

Standard renal transplantation uses external iliac vessels. Iliac or IVC occlusion often excludes candidates, but a patent proximal IVC offers an alternative outflow.

We retrospectively reviewed kidney transplants with IVC anastomosis at a tertiary hospital (Jan 2000-Aug 2024). Outcomes were 30-day mortality and long-term graft survival.

Among 1235 transplants, 14 required IVC anastomosis. Median follow-up was 110 months; median age 34 years; 8/14 were men. Indications included ilio-cava thrombosis, multiple transplants, or adult grafts in low-weight children. Thirteen grafts were placed in the right iliac fossa, one intraperitoneally; 10 were right kidneys, 12 from deceased donors. Seven cases used donor vena cava for vein extension. Two grafts failed (humoral rejection at 5 years; acute ischemia at 3 months). Remaining grafts functioned with mean creatinine 1.55 mg/dL at 5 years. No patient died within 30 days.

With longer End Stage Renal Disease survival, cases with limited vascular access or multiple transplants will rise. Proximal IVC anastomosis, though complex, is feasible and provides durable venous drainage.