Iliocaval Anomaly With Resulting Congestive Nephropathy: A Rare Etiology of Allograft Dysfunction Following Kidney Transplantation.

BACKGROUND

Renal allograft dysfunction warrants prompt investigation as the differential diagnosis is often broad. Here, we present a pediatric kidney transplant recipient who experienced suboptimal allograft function due to previously undiagnosed inferior vena cava stenosis with resultant chronic congestive nephropathy.

METHODS

We retrospectively reviewed a pediatric kidney transplant case at our own institution, and a literature review of congestive nephropathy was performed.

RESULTS

The patient, a 13-year-old male with end-stage renal disease secondary to congenital renal dysplasia, underwent a preemptive living-related-donor kidney transplant. His postoperative course was complicated by the development of a lymphocele on posttransplant day 9, necessitating percutaneous drainage and the subsequent creation of a peritoneal window. Despite successful treatment of mild acute cellular rejection (as established by biopsy) and comprehensive evaluation to exclude alternative etiologies, his posttransplant kidney function remained suboptimal (calculated glomerular filtration rate around 40 mL/min/1.73 m). Approximately 93 weeks posttransplant, he was found to have extensive venous thrombosis involving the iliocaval system and bilateral lower extremity deep veins. The patient underwent successful chemical thrombolysis and serial thrombectomy, resulting in a marked improvement in allograft function. Following thrombolysis, allograft function stabilized, suggesting that the underlying cause of persistent allograft dysfunction was chronic congestive nephropathy due to significant infrarenal inferior vena cava stenosis.

CONCLUSIONS

Iliocaval anomalies can contribute to unexplained kidney allograft dysfunction by causing chronic congestive nephropathy. Failure to recognize and address these anomalies may jeopardize graft function and heighten the risk of graft failure.