Santos Joana Eugénio, Gaspar Ana, Querido Sara, Jorge Cristina, Weigert André, Gabriel Henrique Mesquita, Martinho António, Machado Domingos
Division of Nephrology, Hospital Espírito Santo de Évora, Évora.
Division of Nephrology, Hospital Prof. Dr. Fernando da Fonseca, Amadora.
Clin Nephrol Case Stud. 2021 Feb 19;9:19-25. doi: 10.5414/CNCS110407. eCollection 2021.
Allograft renal vein thrombosis can cause graft loss during the early postoperative period. This diagnosis is sometimes elusive, requiring a strong suspicion. On the other hand, several authors have recognized risk factors for allograft renal vein thrombosis, but neither a preventive approach nor a treatment have been recommended for this complication.
We present a case report of early allograft renal vein thrombosis, preceded by femoral common deep vein thrombosis in a recipient of a third kidney transplant. Despite femoral common deep vein thrombosis treatment with low-molecular-weight heparin and progressive improvement of renal function to a nadir serum creatinine of 0.51 mg/dL, the patient experienced a sudden episode of anuria on postoperative day 5. Doppler ultrasonography strongly suggested the diagnosis of allograft renal vein thrombosis. The patient underwent balloon catheter and aspiration venous thrombectomy, followed by unfractionated heparin perfusion. After 4 days of anuria and multiple blood transfusions, when allograft nephrectomy was contemplated, diuresis suddenly resumed. After 1 year of follow-up, the patient still has a normal renal function.
This case report shows successful treatment of allograft renal vein thrombosis associated with deep vein thrombosis in the first week of transplantation, using balloon catheter and aspiration venous thrombectomy followed by perfusion of unfractionated heparin. The authors suggest this technique as a treatment option for transplant renal vein thrombosis. However, they reinforce the importance of individualized treatment and they remind that a delay may jeopardize the potential benefit of the procedure.
同种异体肾移植肾静脉血栓形成可导致术后早期移植肾丢失。该诊断有时难以捉摸，需要高度怀疑。另一方面，一些作者已经认识到同种异体肾移植肾静脉血栓形成的危险因素，但对于这种并发症既未推荐预防方法也未推荐治疗方法。
我们报告一例早期同种异体肾移植肾静脉血栓形成的病例，该患者为第三次肾移植受者，术前存在股总深静脉血栓形成。尽管使用低分子量肝素治疗股总深静脉血栓形成且肾功能逐渐改善至血清肌酐最低点为0.51mg/dL，但患者在术后第5天突然出现无尿。多普勒超声强烈提示同种异体肾移植肾静脉血栓形成的诊断。患者接受了球囊导管和抽吸静脉血栓切除术，随后进行普通肝素灌注。在无尿4天并多次输血后，考虑进行同种异体肾切除时，突然恢复了利尿。随访1年后，患者肾功能仍正常。
本病例报告显示，在移植的第一周，使用球囊导管和抽吸静脉血栓切除术，随后进行普通肝素灌注，成功治疗了与深静脉血栓形成相关的同种异体肾移植肾静脉血栓形成。作者建议将该技术作为移植肾静脉血栓形成的一种治疗选择。然而，他们强调了个体化治疗的重要性，并提醒延迟可能会危及该手术的潜在益处。
