Pediatric Nephrology

, Volume 23, Issue 12, pp 2107–2109 | Cite as

Renal transplantation in children with thrombosis of the inferior vena cava requires careful assessment and planning

  • Oscar SalvatierraJrEmail author
  • Waldo Concepcion
  • Minnie M. Sarwal
Editorial Commentary


Children with end-stage renal disease and inferior vena cava (IVC) thrombosis are rare, and their condition is complex and high risk for renal transplantation. Detailed imaging studies of the recipient’s abdominal vasculature should be carried out prior to transplantation, followed by careful pre-operative joint planning by the pediatric transplant surgeon and nephrologist. Critical decisions need to be made as to whether a deceased child’s kidney or an adult-sized kidney is to be used, and if the latter, whether it should be from a deceased or living donor. In addition, the contemplated site of the donor’s renal vein anastomosis needs to be determined with a consideration of the possible consequences of the various choices. Sixteen cases of renal transplantation in children with pre-existing IVC thrombosis are reviewed, including the three reported by Shenoy et al. in this journal. With a full understanding of the difficulties noted, renal transplantation in a small child with IVC thrombosis can be successful. However, it requires thorough recipient assessment, coupled with a careful and thoughtful examination of options, to determine the best possible approach to the transplantation.


Thrombosis Inferior vena cava Renal transplantation Venous anastomosis Vascular imaging 


  1. 1.
    Shenoy M, Pararajasingam R, Wright NB, Lewis MA, Parrott N, Riad H, Webb NJA (2008) Successful renal transplantation in children in the presence of thrombosis of the inferior vena cava. Pediatr Nephrol. doi: 10.1007/s00467–007–0736–3
  2. 2.
    Eneriz-Weimer M, Sarwal M, Donovan D, Costaglio C, Concepcion W, Salvatierra O (2006) Successful renal transplantation in high-risk small children with a completely thrombosed inferior vena cava. Transplantation 82:1148–1152CrossRefGoogle Scholar
  3. 3.
    Thomas SE, Hickman RO, Tapper D, Shaw DW, Fouser LS, McDonald RA (2000) Asymptomatic inferior vena cava abnormalities in three children with end-stage renal disease: risk factors and screening guidelines for pretransplant diagnosis. Pediatr Transplant 4:28–34PubMedCrossRefGoogle Scholar
  4. 4.
    Martinez-Urrutia MJ, Periera PL, Ramirez LA, Romera RL, Melgar AA, Monereo EJ, Larrucea JT (2007) Renal transplant in children with previous inferior vena cava thrombosis. Pediatr Transplant 11:419–421PubMedCrossRefGoogle Scholar
  5. 5.
    Salvatierra O, Singh T, Shifrin R, Conley S, Alexander S, Tanney D, Lemley K, Sarwal M, Mackie F, Alfrey E, Orlandi P, Zarins C, Herfkens R (1998) Successful transplantation of adult-sized kidneys into infants requires maintenance of high aortic blood flow. Transplantation 66:819–823PubMedCrossRefGoogle Scholar
  6. 6.
    Steen H, Schwenger V (2007) Good MRI images: to Gad or not to Gad? Pediatr Nephrol 22:1239–1242PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2008

Authors and Affiliations

  • Oscar SalvatierraJr
    • 1
    • 2
    Email author
  • Waldo Concepcion
    • 1
  • Minnie M. Sarwal
    • 2
  1. 1.Department of SurgeryStanford University Medical CenterStanfordUSA
  2. 2.Department of PediatricsStanford University Medical CenterStanfordUSA

Personalised recommendations