Kidney transplant outcomes in patients with superior vena cava obstruction: A Single-Centre Matched Cohort Study

Venous outflow obstruction in kidney transplantation can impair graft function, particularly in renal, iliac or inferior vena cava (IVC) stenosis due to raised venous pressures leading to reduced graft perfusion. Although superior vena cava (SVC) obstruction does not directly affect allograft venous drainage, we wanted to investigate its impact on transplant outcomes.

A single-centre retrospective cohort study of kidney transplants performed between 2018 and 2026 was conducted. All patients with pre-transplant SVC obstruction were included. Controls had no SVC obstruction and were matched 1:3 by donor type, Remuzzi score (±2), recipient age (-2 to +10 years), cold (CIT ±240 minutes) and warm ischaemic times (WIT ±15 minutes). Graft and patient outcomes were compared between both groups.

Seventeen cases were identified and matched to fifty-one controls. In the SVC obstruction group, median recipient age, CIT and WIT were 54 years, 12.5 hours and 36 minutes, respectively, versus 58 years, 12.7 hours and 41 minutes in the control group. Delayed graft function (DGF) occurred in 70.6% of cases (12/17) and 27.5% of controls (14/51). SVC obstruction was associated with an increased DGF risk (OR 4.63 95% CI: 1.56-13.69, p = 0.006). Kaplan-Meier analysis showed poorer graft survival in the SVCO group (p=0.024) CONCLUSION: The implications of SVC obstruction on kidney transplantation has been underexplored. Our findings suggest that SVC obstruction may an impact on short term allograft function. Further evaluation in larger multicentre studies is warranted.