Kidney Transplantation in Children with Thrombosed Inferior Caval Vein – Atypical Vascular Anastomoses

BACKGROUND: Diffuse thrombosis of iliac veins and IVC has been considered a significant technical obstacle in pediatric kidney transplantation (KT). MATERIAL/METHODS: Between 1984 and 2018, 951 KTs were performed in our institution. In 4 children qualified for KT, diffuse thrombosis of iliac veins or IVC was found. The surgical techniques, complications, patient and graft survival, and long-term renal function were studied retrospectively. The patients’ age at transplantation was 2.5–13 years and body mass was 11–39 kg. RESULTS: All children were transplanted with venous anastomoses made to infrahepatic IVC (3 patients) or collateral circulation (1 patient). Early complications developed in 2 patients: significant bleeding from the graft area requiring revision on the second day after transplantation and chyle leak that resolved spontaneously. The follow-up period was 1–12.5 years. Three patients are alive with a follow-up at 7 months, 4.5, and 12 years with serum creatinine 0.7 mg%, 0.6 mg% and 1.4 mg%, respectively. One patient died 1 year after KT, with normal graft function. No late complications related to KT were observed in any patient. CONCLUSIONS: Renal transplantation in pediatric patients with thrombotic vascular complications is associated with a number of technical difficulties and problems.