Nguyen DD, Pham HN, Nguyen HK, Bui KCL, Vo TM, Pham HN. Ovarian vein bypass for renal allograft salvage in iliac vein atrophy: A case report and review of literature. World J Transplant 2026; 16(3): 120920 [DOI: 10.5500/wjt.120920]
Corresponding Author of This Article
Hung Ngoc Pham, MD, PhD, Associate Professor, Department of Urology A, Hue Central Hospital, No 16, Le Loi Street, Thuan Hoa District, Hue 49135, Viet Nam. drhungg@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
case-report
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Nguyen DD, Pham HN, Nguyen HK, Bui KCL, Vo TM, Pham HN. Ovarian vein bypass for renal allograft salvage in iliac vein atrophy: A case report and review of literature. World J Transplant 2026; 16(3): 120920 [DOI: 10.5500/wjt.120920]
Dung Duc Nguyen, Tue Minh Vo, Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Hue Central Hospital, Hue 49135, Viet Nam
Hiep Nhu Pham, Department of Pediatric Surgery and Abdominal Emergency, Hue Central Hospital, Hue 49135, Viet Nam
Hung Khoa Nguyen, Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue 49135, Viet Nam
Kha Cong Le Bui, Department of Urology B, Hue Central Hospital, Hue 49135, Viet Nam
Hung Ngoc Pham, Department of Urology A, Hue Central Hospital, Hue 49135, Viet Nam
Author contributions: Nguyen DD conceived the study, collected and analyzed the clinical data, and drafted the manuscript; Nguyen DD, Pham HN, and Vo TM participated in the surgical procedure; Nguyen DD and Pham HN contributed to the perioperative patient management; Pham HN and Bui KCL assisted with the data collection and literature review; Nguyen HK and Bui KCL contributed to interpretation of the clinical findings and critical revision of the manuscript; Pham HN supervised the study, provided critical intellectual input, and served as the corresponding author; and all authors read and approved the final manuscript.
AI contribution statement: During the preparation of this manuscript, the authors used ChatGPT to assist with language editing, proofreading and improving the formatting and structural organization of the manuscript. After using this tool, the authors carefully reviewed and verified the content as needed and took full responsibility for the content of the publication.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest related to this publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hung Ngoc Pham, MD, PhD, Associate Professor, Department of Urology A, Hue Central Hospital, No 16, Le Loi Street, Thuan Hoa District, Hue 49135, Viet Nam. drhungg@gmail.com
Received: March 16, 2026 Revised: June 5, 2026 Accepted: July 27, 2026 Published online: September 18, 2026 Processing time: 168 Days and 20 Hours
Abstract
BACKGROUND
Failure of venous drainage during reperfusion is an uncommon but serious complication of kidney transplantation that can rapidly compromise graft viability.
CASE SUMMARY
We report a 51-year-old woman with end-stage kidney disease undergoing living-donor kidney transplantation after long-term hemodialysis and prior left femoral dialysis catheterization. Intraoperatively, the left external iliac vein was unexpectedly found to be markedly atrophic, measuring only 3 mm, whereas the graft renal vein measured 12 mm. After initial anastomosis to the external iliac vein, reperfusion caused immediate graft congestion, indicating inadequate venous outflow. A short great saphenous vein interposition graft was therefore used to create an additional drainage pathway from the renal vein to the ipsilateral ovarian vein, which measured 3.7 mm. The graft decompressed immediately, and urine output began within 1 minute. Renal function remained stable, with a serum creatinine level of 65.4 μmol/L at 7 months, and 8-month imaging confirmed bypass patency and adaptive venous enlargement.
CONCLUSION
A small ovarian vein with an autologous conduit can provide a salvage option for unexpected iliac venous pathology in kidney transplantation.
Core Tip: Venous outflow complications during kidney transplantation are uncommon but may threaten immediate graft survival when conventional iliac venous drainage is not feasible. We describe a rare case of unexpected external iliac vein atrophy encountered intraoperatively, where renal allograft venous outflow was successfully salvaged using an ovarian vein bypass augmented with an autologous great saphenous vein conduit. This report emphasizes the importance of flexible intraoperative strategies and demonstrates that the ovarian vein can be adapted as an alternative venous drainage route after appropriate reconstruction, providing a practical solution for unexpected iliac venous insufficiency during renal transplantation.
