2073 SALVAGE OF VASCULAR ACCIDENTS DURING LIVE-DONOR RENAL TRANSPLANTATION: LESSONS FROM 2185 PATIENTS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery1 Apr 20112073 SALVAGE OF VASCULAR ACCIDENTS DURING LIVE-DONOR RENAL TRANSPLANTATION: LESSONS FROM 2185 PATIENTS Ahmed M. Harraz, Shady A. Soliman, Ahmed S. El-Hefnawy, Mohamed M. Kamal, Ahmed I. Kamal, Ahmed B. Shehab El-Din, Ahmed A. Shokeir, and Mohamed A. Ghoneim Ahmed M. HarrazAhmed M. Harraz Mansoura, Egypt More articles by this author , Shady A. SolimanShady A. Soliman Mansoura, Egypt More articles by this author , Ahmed S. El-HefnawyAhmed S. El-Hefnawy Mansoura, Egypt More articles by this author , Mohamed M. KamalMohamed M. Kamal Mansoura, Egypt More articles by this author , Ahmed I. KamalAhmed I. Kamal Mansoura, Egypt More articles by this author , Ahmed B. Shehab El-DinAhmed B. Shehab El-Din Mansoura, Egypt More articles by this author , Ahmed A. ShokeirAhmed A. Shokeir Mansoura, Egypt More articles by this author , and Mohamed A. GhoneimMohamed A. Ghoneim Mansoura, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vascular accidents during renal transplantation represent a major contributor to graft extirpation. However, salvage of vascular accidents is essential for the sake of donor and recipient. We reviewed our experience to demonstrate our techniques and outcome of these events. METHODS Between March 1976 and July 2010, a total number of 2185 patients underwent live-donor renal transplantation (tx) at our center. We retrospectively reviewed our charts to determine patients with vascular accidents; renal artery thrombosis (RAT) and renal vein thrombosis (RVT). Salvage procedures were carried out by second intervention and graft survival was assessed. RESULTS Out of 2185 patients, 23 (1%) vascular accidents occurred. There were 15 males and 8 females with a mean age of 28.4 ± 11 years (range 9–49). RAT and RVT occurred in 19 and 4 patients, respectively. Diagnosis was suspected by sudden cessation of urine output and was confirmed by Doppler US and Magnetic Resonance Angiography. Mean time interval between tx and occurrence was 4.6 ± 9 and 15 ± 13 days in RAT and RVT, respectively. Mean time interval between oliguria or anuria and surgical exploration was (60 ± 14.8) and (48.7 ± 14.3) minutes for RAT and RVT, respectively. The graft was saved in 15 (65.2%) and lost in 8 (34.8%) patients. All cases of RAT were treated by open surgery. Intervention included discontinuation of the arterial anastomosis and thrombectomy, then venotomy was done under proximal control of the renal vein followed by perfusion of the graft with heparinized cold saline until perfusate became clear, finally vascular re-continuity was restored. The graft had been saved in 12 (63%) out of 19 patients with RAT. RVT occurred in 4 patients, the graft had been saved in 3 patients by angiographic local injection of streptokinase in 2 patients and open vascular re-anastomosis after removal of the thrombus in one. On univariate and multivariate analysis, no preoperative factors e.g. time to diagnosis were found to be significantly affecting salvage of the graft. CONCLUSIONS Vascular accidents are uncommon events after renal transplantation. Strict follow-up of renal transplant patient is mandatory and immediate diagnosis is crucial for graft salvage. Angiographic local injection of streptokinase in graft vein is a viable alternative for graft survival. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e829-e830 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Ahmed M. Harraz Mansoura, Egypt More articles by this author Shady A. Soliman Mansoura, Egypt More articles by this author Ahmed S. El-Hefnawy Mansoura, Egypt More articles by this author Mohamed M. Kamal Mansoura, Egypt More articles by this author Ahmed I. Kamal Mansoura, Egypt More articles by this author Ahmed B. Shehab El-Din Mansoura, Egypt More articles by this author Ahmed A. Shokeir Mansoura, Egypt More articles by this author Mohamed A. Ghoneim Mansoura, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...