Kidney transplantation in children with extended ilio-caval thrombosis

Kidney transplantation requires the anastomosis of the graft's kidney vein to the recipient's iliac vein or inferior vena cava (IVC). The venous reconstruction can be challenging in case of extended ilio-caval thrombosis.

We report the case of a child with Denis Drash syndrome, with right Wilms tumor and intra-caval tumoral extension, left nodules of nephroblastomatosis on a horseshoe kidney, proteinuria, and progressive kidney failure, resulting in bilateral nephrectomy and iliac veins and vena cava thrombosis extended to the retro-hepatic IVC. At the age of 7 years, 32 months after the end of the oncological treatment, she underwent kidney transplantation. Venous reconstruction was achieved by using the donor IVC as a venous conduit anastomosed to the recipient's retro-hepatic IVC at the level of the hepatic veins.

Postoperative course was uneventful, and the child is alive and well, free of tumor and with normal kidney function, 5 years after the end of oncological treatment, and 32 months after transplantation.

This technique appears as a safe and physiological alternative to previously described venous anastomoses to the portal system or pelvic varices, preventing chronic venous hypertension of the graft.