POST-TRANSPLANT RENAL ARTERY KINKING ASSOCIATED WITH THE PATIENT'S POSITION: CASE-REPORT
Introduction: Transplant renal artery kinking is an unusual post-kidney transplant complication usually associated with early graft dysfunction.
Methods: We present an unusual clinical manifestation of post-transplant renal artery kinking. A review of the clinical process was made with patient consent.
Results: A 52-year-old male with end-stage renal disease secondary to IgA nephropathy was submitted to cadaveric donor kidney transplant. The patient had good renal function postoperatively, however, after three months the patient began a gradual reduction of diuresis and worsening of renal function, needing to remain in a “squatting position” 5 hours a day to maintain a normal urine output. A bypass between the left external iliac artery and the graft renal artery with an ipsilateral autologous great saphenous vein was made to correct a renal artery kinking and the patient fully recovered.
Conclusion: Renal artery kinking commonly manifested as renal graft dysfunction may have a singular form of presentation. Early intervention is essential to preserve graft viability.
2. Osman Y, Shokeir A, Ali-el-Dein B, et al. Vascular complications after live donor renal transplantation: study of risk factors and effects on graft and patient survival. J Urol 2003; 169(3): 859–62.
3. Miah M, Madaan S, Kessel DJ, Newstead CG, Guleria S. Transplant renal artery kinking: a rare cause of early graft dysfunction. Nephrol Dial Transplant 2004; 19(7): 1930–1.
4. Chua GC, Snowden S, Patel U. Kinks of the transplant renal artery without accompanying intraarterial pressure gradient
do not require correction: five-year outcome study. Cardiovasc Intervent Radiol 2004; 27(6): 643–50.
5. Ayvazoglu Soy EH, Akdur A, Kirnap M, Boyvat F, Moray G, Haberal M. Vascular Complications After Renal Transplant: A Single-Center Experience. Exp Clin Transplant 2017; 15(Suppl 1): 79–83.
6. Ghazanfar A, Tavakoli A, Augustine T, Pararajasingam R, Riad H, Chalmers N. Management of transplant renal artery stenosis and its impact on long-term allograft survival: a single-centre experience. Nephrol Dial Transplant 2011; 26(1): 336–43.
7. Buturovic-Ponikvar J. Renal transplant artery stenosis. Nephrol Dial Transplant 2003; 18 Suppl 5: v74-7.
8. Granata A, Clementi S , Londrino F, e t al. Renal t ransplant vascular complications: the role of Doppler ultrasound. J Ultrasound 2015; 18(2): 101–7.
9. Irshad A, Ackerman SJ, Campbell AS, Anis M. An overview of renal transplantation: current practice and use of ultrasound. Semin Ultrasound CT MR 2009; 30(4): 298–314.
10. Reddy VS, Guleria S, Abdullah S, Bansal R. A kink in transplantation: A rare cause of early graft dysfunction. Saudi Journal of Kidney Diseases and Transplantation 2013; 24(5): 965–8.
11. Meier R, Fournier I, Toso C, Berney T, Bednarkiewicz M. Surgical Repair of a Living-Donor Kidney Graft Artery Kink by a Postanastomotic External Iliac Artery Rotation and Reanastomosis. Ann Vasc Surg 2017; 44: 414 e5- e9.
12. Ngo AT, Markar SR, De Lijster MS, Duncan N, Taube D, Hamady MS. A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis. Cardiovasc Intervent Radiol 2015; 38(6): 1573–88.
13. Rouer M, Godier S, Monnot A, et al. Long-term Outcomes after Transplant Renal Artery Stenosis Surgery. Ann Vasc Surg 2018.
14. Kolli KP, LaBerge JM. Interventional Management of Vascular Renal Transplant Complications. Tech Vasc Interv Radiol 2016; 19(3): 228–36.