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Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava
BACKGROUND: Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow. METHODS: We conducted a retrospective study...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946523/ https://www.ncbi.nlm.nih.gov/pubmed/27500272 http://dx.doi.org/10.1097/TXD.0000000000000592 |
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author | Shishido, Seiichiro Kawamura, Takeshi Hamasaki, Yuko Takahashi, Yusuke Itabashi, Yoshihiro Muramatsu, Masaki Satoh, Hiroyuki Aikawa, Atsushi |
author_facet | Shishido, Seiichiro Kawamura, Takeshi Hamasaki, Yuko Takahashi, Yusuke Itabashi, Yoshihiro Muramatsu, Masaki Satoh, Hiroyuki Aikawa, Atsushi |
author_sort | Shishido, Seiichiro |
collection | PubMed |
description | BACKGROUND: Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow. METHODS: We conducted a retrospective study of 11 transplants in 9 patients with end-stage renal disease and thrombosed IVCs who received adult kidney allografts between 2000 and 2015. The mean age at transplantation was 7.5 ± 3.5 years. A pretransplant diagnosis of the IVC thrombosis was made in 7 patients by magnetic resonance imaging and computerized tomography, whereas there were 2 instances of intraoperative discovery of the IVC thrombosis. RESULTS: In the early cases, a kidney was placed intraperitoneally at the right iliac fossa with a venous anastomosis to the patent segment of the suprarenal IVC. After 2008, however, 6 adult-sized kidneys were subsequently placed in the left orthotopic position. Venous drainage was attained to the infrahepatic IVC (n = 3), left native renal vein (n = 2), and ascending lumbar vein (n = 1). Moreover, a venous bypass was created between the graft and the splenic vein in 2 children who showed high return pressure after the vessel was declamped. The mean glomerular filtration rate of the functioning 8 grafts 1 year posttransplant was 73.4 ± 20.4 mL/min per 1.73 m(2). Of note, 6 of the grafts have been functioning well, with a mean follow-up of 66 months. Both 1- and 5-year graft survival were 81.8%. CONCLUSIONS: Transplantation into the left orthotopic position and the revascularization methods are an effective set of surgical techniques that could potentially be adopted as safe and reliable transplant approaches in children with IVC thrombosis. |
format | Online Article Text |
id | pubmed-4946523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-49465232016-08-05 Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava Shishido, Seiichiro Kawamura, Takeshi Hamasaki, Yuko Takahashi, Yusuke Itabashi, Yoshihiro Muramatsu, Masaki Satoh, Hiroyuki Aikawa, Atsushi Transplant Direct Kidney Transplantation BACKGROUND: Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow. METHODS: We conducted a retrospective study of 11 transplants in 9 patients with end-stage renal disease and thrombosed IVCs who received adult kidney allografts between 2000 and 2015. The mean age at transplantation was 7.5 ± 3.5 years. A pretransplant diagnosis of the IVC thrombosis was made in 7 patients by magnetic resonance imaging and computerized tomography, whereas there were 2 instances of intraoperative discovery of the IVC thrombosis. RESULTS: In the early cases, a kidney was placed intraperitoneally at the right iliac fossa with a venous anastomosis to the patent segment of the suprarenal IVC. After 2008, however, 6 adult-sized kidneys were subsequently placed in the left orthotopic position. Venous drainage was attained to the infrahepatic IVC (n = 3), left native renal vein (n = 2), and ascending lumbar vein (n = 1). Moreover, a venous bypass was created between the graft and the splenic vein in 2 children who showed high return pressure after the vessel was declamped. The mean glomerular filtration rate of the functioning 8 grafts 1 year posttransplant was 73.4 ± 20.4 mL/min per 1.73 m(2). Of note, 6 of the grafts have been functioning well, with a mean follow-up of 66 months. Both 1- and 5-year graft survival were 81.8%. CONCLUSIONS: Transplantation into the left orthotopic position and the revascularization methods are an effective set of surgical techniques that could potentially be adopted as safe and reliable transplant approaches in children with IVC thrombosis. Lippincott Williams & Wilkins 2016-05-23 /pmc/articles/PMC4946523/ /pubmed/27500272 http://dx.doi.org/10.1097/TXD.0000000000000592 Text en Copyright © 2016 The Authors. Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. |
spellingShingle | Kidney Transplantation Shishido, Seiichiro Kawamura, Takeshi Hamasaki, Yuko Takahashi, Yusuke Itabashi, Yoshihiro Muramatsu, Masaki Satoh, Hiroyuki Aikawa, Atsushi Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava |
title | Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava |
title_full | Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava |
title_fullStr | Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava |
title_full_unstemmed | Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava |
title_short | Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava |
title_sort | successful kidney transplantation in children with a compromised inferior vena cava |
topic | Kidney Transplantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946523/ https://www.ncbi.nlm.nih.gov/pubmed/27500272 http://dx.doi.org/10.1097/TXD.0000000000000592 |
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