• Mycotic pseudoaneurysm
• femoral vein bypass
• transplant

• Arterial stenting
• Transplanted kidney
• Venous stenting

• Ferumoxytol
• Kidney transplant
• Liver transplant
• Magnetic resonance angiography
• Pancreas transplant
• Solid organ transplant

• Humans
• Ferrosoferric Oxide
• Contrast Media
• Magnetic Resonance Angiography/methods
• Abdomen/diagnostic imaging
• Abdomen/blood supply
• Allografts

• Novo Nordisk Fonden

• Clinical outcomes
• Kidney
• Surgical complications
• Transplantation

• Humans
• Kidney Transplantation/adverse effects
• Male
• Female
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Adult
• Kidney Failure, Chronic/surgery
• Graft Survival
• Patient Readmission/statistics & numerical data
• Retrospective Studies
• Treatment Outcome
• Aged
• Time Factors

• coil embolization
• endovascular
• kidney transplant
• pseudoaneurysm

• Female
• Humans
• Middle Aged
• Kidney Transplantation/adverse effects
• Aneurysm, False/diagnostic imaging
• Aneurysm, False/etiology
• Aneurysm, False/surgery
• Treatment Outcome
• Kidney
• Renal Artery/diagnostic imaging
• Renal Artery/surgery

• heterotopic
• kidney
• orthotopic
• renal
• transplantation

• Adult
• Humans
• Kidney Transplantation
• Graft Survival
• Kidney
• Transplants
• Postoperative Complications/etiology

• case report
• graft dysfunction
• hypertension
• pseudoaneurysm
• renal artery stenosis
• renal transplantation

• Imaging of renal allografts
• Immediate and late
• Renal transplant complications
• Transplant kidney

• Endovascular stent
• Kidney transplantation
• Psudoaneurysm

• diagnostic and therapeutic strategies
• open surgery
• percutaneous transluminal angioplasty
• renal transplantation
• vascular complications

• Complications
• Face transplantation
• Hand transplantation
• Rejection
• Vascularized composite allotransplantation

• color coded Duplex sonography
• kidney transplantation
• post-transplant complications
• resistive index
• ultrasound

• Orthotopic kidney transplantation
• kidney graft
• meta-analysis
• overall survival
• systematic review

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

• Aorta, Abdominal
• Arterial Occlusive Diseases/diagnostic imaging
• Arterial Occlusive Diseases/etiology
• Arterial Occlusive Diseases/surgery
• Humans
• Iliac Artery/diagnostic imaging
• Iliac Artery/surgery
• Kidney
• Kidney Transplantation/adverse effects
• Male
• Middle Aged

• Arteriovenous fistula
• graft biopsy
• graft rejection
• kidney transplantation
• selective embolization

•

Severe atherosclerosis is a complicated condition in patients with CKD and as the number of waiting list for renal transplantation rose, the rate is increasing.

Severe atherosclerosis is a complicated condition in chronic kidney disease (CKD) and could lead to the operation’s failure, when it was not detectable by pre-operative diagnostic imaging. Several methods including two-stage approach, synthetic graft, stent… have been reported, but complications (i.e. infection, graft rejection) are a matter of concern. The aim of this case is to provide the one-stage approach, in which renal transplantation and vascular reconstruction using fresh homografts from one brain-dead donor were used.

We reported a case of a 33-year-old male, who was diagnosed with CKD caused by chronic glomerulonephritis since the age of 28 and had been on hemodialysis. Not until did the transplantation take place that the operation team spotted the atherosclerotic external iliac artery, and vessel graft from the same donor was used and the renal was transplanted. The patient was discharged 14 days after the surgery without any complications.

Kidney transplantation has revolutionized the life of patients with end-stage renal disease (ESRD). Around 6% of patients have severe atherosclerosis and the figure is increasing. Vascular degradation in ESRD might lead to unsuccessful operation. One-stage approach (including renal transplantation and external iliac artery replacement) using homograft from one doner is feasible to handle the situation.

Severe atherosclerosis often accompanies with CKD. The difficulties of doing arterial anastomosis increases, which requires advanced techniques to deal with. Surgeons should be prepared about this circumstance. One-stage approach using one donor’s homografts, is a possible and safe procedure.

• Arterial homograft
• Atherosclerotic iliac vessel
• Case report
• Kidney transplantation
• Vascular complications

• Deceased donor
• Kidney transplant
• Living donor
• Psychologic status
• Socioeconomic

• Adult
• Donor Selection/statistics & numerical data
• Female
• Humans
• Iran/epidemiology
• Kidney Transplantation/psychology
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Prospective Studies
• Socioeconomic Factors
• Tissue Donors/statistics & numerical data
• Transplant Recipients/psychology
• Treatment Outcome
• Waiting Lists

• kidney transplant
• positional
• standing ultrasonography
• vascular kinking

• Aged
• Female
• Humans
• Ischemia/diagnostic imaging
• Ischemia/etiology
• Kidney/blood supply
• Kidney/diagnostic imaging
• Kidney Transplantation
• Patient Positioning
• Primary Graft Dysfunction/diagnostic imaging
• Primary Graft Dysfunction/etiology
• Standing Position
• Ultrasonography

Anastomotic pseudoaneurysm is one of the rarest vascular complications after renal transplant surgery. Therapeutic options include open surgical repair or endovascular stenting.

Case 1 had pseudoaneurysm involving external iliac artery and was managed by jump graft to allograft using cadaveric donor iliac arteries and patch angioplasty repair of external iliac artery after excising pseudoaneurysm. Case 2 had undergone orthotopic renal transplant with spleno‐renal arterial anastomosis and developed a massive pseudoaneurysm proximal to spleno‐renal arterial anastomosis. This patient underwent endovascular stenting preserving allograft vascularity and graft function. Outcome in both patients was successful with normalization of renal function to baseline levels.

Treatment of renal transplant anastomotic pseudoaneurysms is difficult and associated with high rates of graft loss. Open surgery is the gold standard providing several possibilities for arterial reconstruction preserving graft and limb circulation. Endovascular treatment should be considered in high‐risk surgical patients with favorable anatomy.

• anastomotic pseudoaneurysm
• endovascular stenting
• jump graft
• renal transplant
• vascular complication
• vascular repair

Transplant renal vein thrombosis (TRVT) is a severe vascular complication and is caused by various factors, including recipient factors, donor factors, immunosuppression regimens, and surgical techniques. Despite adequate interventions, including thrombolytic therapy or surgical thrombectomy, successful salvage of the allograft is often difficult. We observed a case of TRVT induced by compression of the renal vein immediately after intraoperative abdominal closure.

A 41-year-old male underwent ABO-compatible living kidney transplantation. The donor was his 45-year-old sister, and her right kidney was donated. The allograft had a single artery and vein. One of the preoperative recipient problems was obesity (body mass index, 33.4 kg/m²). Intraoperative Doppler ultrasonography (US) revealed sufficient blood flow throughout the allograft, and urine output was also observed. After surgery, hematuria was observed; the urine output decreased and serum creatinine levels increased to 7.0 mg/dL. Doppler US showed a decrease in diastolic flow and an elevated resistive index, which were similar findings to those noted in acute rejection. Although steroid pulse therapy was initiated, allograft dysfunction was worsening. On postoperative day 4, surgical exploration revealed TRVT; consequently, thrombectomy was performed. The urine output increased, and serum creatinine levels decreased to 1.8 mg/dL. The cause of TRVT development may be that the transplant renal vein was relatively short, due to the right kidney being compressed by surrounding tissues after abdominal closure, and that TRVT was gradually developing due to stagnant blood flow.

Although TRVT is induced by multiple factors, an accurate diagnosis is often difficult. Understanding these factors, including obesity, and considering TRVT as a cause of allograft dysfunction are important during the pre-, peri-, and postoperative periods. Knowledge of TRVT can lead to early and accurate diagnosis and intervention, resulting in better outcomes for the patients with allograft dysfunction.

• kidney transplantation
• surgical exploration
• thrombectomy
• transplant renal vein thrombosis

• Expandable hydrogel coils
• Outcomes
• Pseudoaneurysm
• Transplant renal artery

Surgical thrombectomy in the context of acute renal vein thrombosis (RVT) post-transplantation has had limited success, with considerable variation in the surgical techniques used. Unfortunately, it is usually followed by allograft nephrectomy within a few days if rapid allograft recovery does not ensue. We report a case of acute RVT in which nephrectomy was not performed despite a prolonged requirement for dialysis post-thrombectomy, but with recovery of renal function 2 weeks later. We also report the findings of serial MRI with diffusion-weighted imaging (DW-MRI) throughout the patient’s recovery, which provided novel insights into allograft microvascular perfusion changes post-thrombectomy.

A 65-year old patient underwent living-unrelated kidney transplantation complicated by acute RVT. Surgical thrombectomy and irrigation led to a delayed, but significant, recovery of renal function. Serial non-contrast DW-MRI scanning was used to non-invasively assess microvascular renal blood flow post-operatively. Unlike standard Doppler ultrasonography, DW-MRI documented reduced microvascular perfusion initially, with gradual but incomplete recovery that mirrored the partial improvement in renal function.

Our findings suggest that surgical thrombectomy may be more effective than previously described if followed by careful patient observation. Moreover, diffusion-weighted MRI appears to provide important insights into the pathophysiology of delayed graft function and deserves further investigation.

• Case report
• Delayed graft function
• Diffusion weighted magnetic resonance imaging
• Kidney transplantation
• Renal vein thrombosis

• Animals
• Disease Models, Animal
• Female
• Kidney/blood supply
• Kidney/diagnostic imaging
• Kidney Transplantation/adverse effects
• Microdialysis
• Renal Artery/diagnostic imaging
• Renal Circulation
• Renal Veins/diagnostic imaging
• Swine
• Treatment Failure
• Ultrasonography

• Helen and Ejnar Bjørnows foundation
• Institute of Clinical Medicine, Aarhus University Hospital
• Søster and Verner Lipperts Foundation

Infectious vascular complications affecting transplant recipients may lead to severe morbidity and graft loss. This is a retrospective review of vascular repair with bovine pericardial patch (BPP) in infected fields for immunosuppressed patients. BPP was used as either a patch or an interposition graft. Five cases of arterial reconstruction in infected fields using BPP were performed. There were no complications related to bleeding, thrombosis, or recurrent infection. In our limited experience, the use of BPP as a vascular patch is successful, and it represents an alternative when vascular reconstruction is needed in the context of infected fields.

Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grew Enterococcus faecium and Pseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yielded P. aeruginosa. Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grew P. aeruginosa, and he was put on imipenem and cilastatin (tienam), colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world’s literature in which a P. aeruginosa infectious anastomotic pseudoaneurysm developed after a renal allograft.

• in situ interposition bypass graft
• infectious anastomotic pseudoaneurysm
• multidrug-resistant Pseudomonas aeruginosa
• renal allograft artery
• renal transplant

Ultrasound is routinely performed at our transplant unit within the first 48 h of kidney transplantation (KTX). The objective of this study was to evaluate the association of ultrasound results and, in particular, elevated resistance indices (RIs) with the occurrence of surgical complications and allograft outcomes.

The study included all kidney allograft recipients undergoing transplantation at our center between January 2010 and December 2011 (N = 329). Ultrasound examination was performed on 315 recipients (95.7%).

Delayed graft function was more common in subjects with a high RI (≥0.7) than in patients with an RI < 0.7 (47.2 vs. 28.2%; p = 0.032). A lack of arterial signal was detected in eight patients (2.5%), of whom five had a vascular complication that required surgical therapy. In 12 patients (3.8%), RI was 1 without any other signs of vascular impairment. Even though such values can be a sign of venous thrombosis, no case was observed in any of these patients.

The results of our study suggest that ultrasound evaluation of the transplanted kidney shortly after transplantation is a valuable tool not only for detecting vascular complications but also as a predictor of graft outcome regarding delayed graft function.

• Complications
• Kidney transplantation
• Outcome
• Ultrasound
• Vascular

• Adolescent
• Adult
• Aged
• Angiography
• Child
• Child, Preschool
• Female
• Humans
• Incidence
• Infant
• Kidney Transplantation/adverse effects
• Kidney Transplantation/methods
• Male
• Middle Aged
• Reoperation
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Turkey/epidemiology
• Vascular Diseases/diagnostic imaging
• Vascular Diseases/epidemiology
• Vascular Diseases/surgery
• Vascular Surgical Procedures/adverse effects
• Vascular Surgical Procedures/methods
• Young Adult

• Humans
• Intraoperative Complications
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/mortality
• Kidney Failure, Chronic/surgery
• Kidney Transplantation/adverse effects
• Kidney Transplantation/nursing
• Nephrectomy
• Perioperative Nursing
• Postoperative Complications
• Preoperative Period

The lengths of right renal veins are shorter when compared to their left counterparts. Since the implantation of kidneys with short renal veins is considered more challenging, many surgeons prefer left kidneys for transplantation. Therefore, our hypothesis is that the implantation of right kidneys from living and deceased donors is associated with more technical graft failures as compared to left kidneys.

Two consecutive cohorts of adult renal allograft recipients of living (n = 4.372) and deceased (n = 5.346) donor kidneys between January 1, 2000 and January 1, 2013 were analyzed. Data were obtained from the prospectively maintained electronic database of the Dutch Organ Transplant Registry. Technical graft failure was defined as failure of the renal allograft within 10 days after renal transplantation without signs of acute rejection.

In the living donor kidney transplantation cohort, the implantation of right donor kidneys was associated with a higher incidence of technical graft failure (multivariate analysis p = 0.03). For recipients of deceased donor kidneys, the implantation of right kidneys was not significantly associated with technique-related graft failure (multivariate analysis p = 0.16).

Our data show that the implantation of right kidneys from living donors is associated with a higher incidence of technique-related graft failure as compared to left kidneys.

Secondary causes of minimal change disease (MCD) account for a minority of cases compared to its primary or idiopathic form and provide ground for consideration of common mechanisms of pathogenesis. In this paper we report a case of a 27-year-old Latina woman, a renal transplant recipient with systemic lupus erythematosus (SLE), who developed nephrotic range proteinuria 6 months after transplantation. The patient had recurrent acute renal failure and multiple biopsies were consistent with MCD. However, she lacked any other features of the typical nephrotic syndrome. An angiogram revealed a right external iliac vein stenosis in the region of renal vein anastomosis, which when restored resulted in normalization of creatinine and relief from proteinuria. We report a rare case of MCD developing secondary to iliac vein stenosis in a renal transplant recipient with SLE. Additionally we suggest that, in the event of biopsy-proven MCD presenting as an atypical nephrotic syndrome, alternative or secondary, potentially reversible, causes should be considered and explored.

• Interventional therapy
• transplant renal artery pseudoaneurysms
• transplant renal artery stenosis
• transplant renal venous kinking
• transplanted renal allograft

• angioplasty
• complications
• interventional radiology
• organ transplantation
• percutaneous

• Chronic kidney disease
• organ failure
• thrombophilia
• thrombosis

• Cortical mechanical behavior
• Kidney biopsy
• Poroelasticity
• Renal vein occlusion
• Ultrasound elasticity imaging

• End stage renal failure
• Organ transplant
• Renal replacement therapy
• Transplant renal artery stenosis
• Transplant renal artery thrombosis
• Transplantation

• allografts
• renal transplantation
• salvage
• vascular thrombosis