Acute thrombosis of renal transplant artery: graft salvage by means of intra-arterial fibrinolysis.
BACKGROUND
Arterial thrombosis in a transplanted kidney is a serious complication that usually leads to graft loss. The purpose of our study was to evaluate intra-arterial fibrinolysis as a treatment of acute renal transplant artery thrombosis and to determine the maximum period of occlusion allowing a reasonable chance of graft salvage.


RESULTS
Four patients underwent intra-arterial fibrinolysis for acute transplant artery thrombosis. Transplantations had been performed 29 days to 10 years before the fibrinolysis. Fibrinolysis was carried out by using recombitant tissue plasminogen activator (n=1) or urokinase (n=3). In one patient, anuric for 13 hr at admittance, fibrinolysis could not revascularize the graft artery. In a second patient, anuric for 48 hr at admittance, fibrinolysis did revascularize the graft artery, but dialysis could not be discontinued. In the two remaining patients, anuric for 19 and 20 hr at admittance, the graft artery was successfully revascularized and dialysis could be discontinued 1 week later. One of these two patients returned to dialysis 71 months later because of chronic rejection. Thirty-four months after the acute episode, the remaining patient had a patent artery and did not require dialysis.


CONCLUSIONS
Fibrinolysis seems an efficient treatment that may save transplants after up to 24 hr of the arterial occlusion.
Rouvière
Olivier
O
Department of Genitourinary and Vascular Radiology, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France. olivier.rouviere@netcourrier.com
Berger
Pascal
P
Béziat
Christophe
C
Garnier
Jane-Luce
JL
Lefrançois
Nicole
N
Martin
Xavier
X
Lyonnet
Denis
D
D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*