Successful renal transplantation in children in the presence of thrombosis of the inferior vena cava


Thrombosis of the inferior vena cava (IVC) has previously been considered to be a contraindication to renal transplantation in children because of the technical difficulties associated with surgery and the increased risk of graft thrombosis. We report three children with previous IVC thrombosis who underwent renal transplantation at our institution over the last 5 years. The pretransplant imaging of these patients included direct venography or magnetic resonance venography to evaluate venous outflow. Two children (19 kg and 36 kg) received deceased donor renal allografts with no surgical complications or delayed graft function. At the latest follow-up 3.0 and 4.6 years posttransplantation, respectively, they were well, with estimated glomerular filtration rates of 52 and 64 ml/min per 1.73 m2, respectively. The third child underwent a live-related-donor renal transplant at the age of 4.9 years (weight 13.5 kg). There was primary graft nonfunction. Renal vein thrombosis was noted on postoperative day 12, with subsequent graft loss. Children with previous IVC thrombosis can be successfully transplanted with adult-sized kidneys provided detailed evaluation of the venous drainage has been performed. There is substantial risk of graft thrombosis, and detailed counselling regarding the specific risks of the procedure is essential.

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  1. 1.

    Goldstein SL, Graham N, Burwinkle T, Warady B, Farrah R, Varni JW (2006) Health-related quality of life in pediatric patients with ESRD. Pediatr Nephrol 21:846–850

    Article  Google Scholar 

  2. 2.

    Adams J, Gudemann C, Tonshoff B, Mehls O, Wiesel M (2001) Renal transplantation in small children - a comparison between surgical procedures. Eur Urol 40:552–556

    CAS  Article  Google Scholar 

  3. 3.

    Salvatierra O, Alexander SR, Krensky AM (1998) Pediatric transplant grand rounds. Pediatric kidney transplantation at Stanford. Pediatr Transplant 2:165–176

    PubMed  Google Scholar 

  4. 4.

    Shefler A, Gillis J, Lam A, O’Connell AJ, Schell D, Lammi A (1995) Inferior vena cava thrombosis as a complication of femoral vein catheterisation. Arch Dis Child 72:343–345

    CAS  Article  Google Scholar 

  5. 5.

    Eneriz-Weimer M, Sarwal MM, Donovan D, Costaglio C, Concepcion W, Salvatierra O (2006) Successful renal transplantation in high-risk small children with a completely thrombosed inferior venacava. Transplantation 82:1148–1152

    Article  Google Scholar 

  6. 6.

    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 11:419–421

    Article  Google Scholar 

  7. 7.

    Satterthwaite R, Aswad S, Sunga V, Shidban H, Mendez RG, Bogaard T, Asai P, Khetan U, Magpayo M, Mendez R (1997) Outcome of en bloc and single kidney transplantation in from very young cadaveric donors. Transplantation 63:1405–1410

    CAS  Article  Google Scholar 

  8. 8.

    Al-Alkash SI, Ettenger (2005) Kidney transplantation in children. In: Danovitch GM (eds) 4th edition of Handbook of Kidney Transplantation. Lippincott, Williams & Wilkins, pp 414–450

  9. 9.

    Alexander F, Campbell WA (1971) Congenital nephrotic syndrome and renal vein thrombosis in infancy. J Clin Pathol 24:27–40

    CAS  Article  Google Scholar 

  10. 10.

    Thomas SE, Hickman RO, Tapper D, Shaw DW, Fouser LS (2000) A symptomatic inferior vena cava abnormalities in three children with end-stage renal disease: risk factors and screening guidelines for pretransplant diagnosis. Pediatr Transplant 4:28–34

    CAS  Article  Google Scholar 

  11. 11.

    Halbmayer WM, Radek J, Duschet P, Lindeck G, Gschnait F, Czembirek H, Fischer M (1993) Recurrent venous thromboses in hypoplasia of the vena cava inferior and factor XII deficiency. Dtsch Med Wochenschr 118:1561–1566

    CAS  Article  Google Scholar 

  12. 12.

    Münchow N, Kosch A, Schobess R, Junker R, Auberger K, Nowak-Gottl U (1999) Role of genetic prothrombotic risk factors in childhood cava vein thrombosis. Eur J Pediatr 158(Suppl 3):S109–S112

    Article  Google Scholar 

  13. 13.

    Yata N, Nakanishi K, Uemura S, Ishikura K, Hataya H, Ikeda M, Honda M, Yoshikawa N (2004) Evaluation of the inferior venacava in potential pediatric renal transplant recipients. Pediatr Nephrol 19:1062–1064

    Article  Google Scholar 

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Correspondence to Nicholas J. A. Webb.

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Shenoy, M., Pararajasingam, R., Wright, N.B. et al. Successful renal transplantation in children in the presence of thrombosis of the inferior vena cava. Pediatr Nephrol 23, 2261–2265 (2008).

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  • Transplant
  • Inferior vena cava
  • Thrombosis
  • Renal imaging
  • Technical issues