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Case Reports: Learning from unexpected outcome (positive or negative)
Rescue of an asymptomatic arterial occlusion after kidney transplant
  1. Yash Kadakia1,
  2. Christine Hwang2 and
  3. Malcolm MacConmara2
  1. 1The University of Texas Southwestern Medical Center, Dallas, Texas, USA
  2. 2Department of Surgery, Division of Surgical Transplantation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Christine Hwang; Christine.Hwang{at}UTSouthwestern.edu

Abstract

Arterial injury leading to vascular occlusion is a rare complication of kidney transplantation that requires urgent intervention to salvage the kidney and prevent graft loss. Occasionally, the recipient iliac vessels may be injured, resulting in acute ischaemia of the lower extremity in addition to loss of blood flow to the kidney transplant. In the case presented here, a 58-year-old man with chronic kidney disease secondary to IgA nephropathy underwent pre-emptive deceased donor renal transplantation complicated by an external iliac artery (EIA) dissection proximal to the transplant anastomosis. However, as a result of retrograde blood flow from collateral vessels, perfusion of the kidney and right lower extremity was initially preserved and early diagnosis was made after post-transplant ultrasound. This report reviews the aetiology, clinical features and therapeutic options for arterial injuries post-transplant. This case also highlights the importance of post-transplant vigilance and the value of routine postoperative ultrasound imaging.

  • renal transplantation
  • renal intervention
  • transplantation
  • vascular surgery
  • ultrasonography

https://doi.org/10.1136/bcr-2021-247347

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    Footnotes

    • Contributors CH and MM were the transplant surgeons who were involved in this patient’s care. Conception and design—CH, MM. Acquisition of data or analysis—YK. Interpretation of data—YK, CH, MM. Drafting the article or revising it critically for important intellectual content—YK, CH, MM. Final approval of the version published—YK, CH, MM. Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved—YK, CH, MM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.