title: Salvage of grafts with vascular thrombosis during live donor renal allotransplantation: a critical analysis of successful outcome.
abstract: OBJECTIVE
  To report a high-volume institution experience with salvage techniques for vascular accidents during live donor renal allotransplantation.
  
  
  METHODS
  Between March 1976 and January 2011, 2208 recipients underwent live donor renal allotransplantation. A retrospective review of recipients with vascular accidents - renal artery thrombosis and renal vein thrombosis - was carried out. Salvage procedures were recorded and their outcomes were assessed.
  
  
  RESULTS
  A total of 23 (1%) vascular accidents occurred, including renal artery thrombosis and renal vein thrombosis in 19 (0.8%) and four (0.18%) recipients, respectively. All renal artery thrombosis patients were treated by open revascularization and the graft was salvaged in 12 patients (63%). Two renal vein thrombosis events were resolved by percutaneous catheter-directed thrombolytic therapy. Of the other two allografts, one was salvaged by thrombectomy and revascularization, and the other was lost. On univariable analysis, older recipients (P = 0.003), pretransplant hypertension (P =  0.001), more human leukocyte antigen mismatches (≥3; P = 0.036), shorter ischemia time (≤45 min; P = 0.004) and longer time to diagnosis (>3.5 days; P = 0.013) were significantly associated with non-salvage of the graft after vascular accidents. Nevertheless, none of these variables were significant on the multivariable analysis. Over a median follow up of 35 months, the median (range) serum creatinine was 2 mg/dL (range 0.8-8.8 mg/dL), and 11 (79%) recipients were living with functioning grafts.
  
  
  CONCLUSIONS
  Despite the devastating complications, vascular accidents are salvageable and revascularization is crucial for graft salvage. Angiographic percutaneous techniques are viable alternatives for renal vein thrombosis.
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Harraz
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
authors.forename: Shady A
authors.initials: SA
authors.lastname: Soliman
authors.forename: Yasser
authors.initials: Y
authors.lastname: Osman
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: El-Hefnawy
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Zahran
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Kamal
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Kamal
authors.forename: Bedeir
authors.initials: B
authors.lastname: Ali-El-Dein
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens; D006801:Humans; D006973:Hypertension / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012082:Renal Veins; D012189:Retrospective Studies; D016879:Salvage Therapy; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D052096:Warm Ischemia; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D003404:Creatinine
keywords: allografts; renal transplantation; salvage; vascular thrombosis