title: Acute thrombosis of a transplanted renal artery after gastric ulcer bleeding in a patient with a long-term well-functioning renal allograft: A case report and literature review.
abstract: BACKGROUND
  Acute thrombosis of a transplanted renal artery is a serious vascular complication following renal allograft transplantation, which usually occurs within the first month after transplantation and often results in graft loss. It rarely occurs beyond the first month, except in a rejected kidney or in a kidney with high-grade transplant renal artery stenosis.
  
  
  RESULTS
  A 65-year-old male with a history of type 2 diabetes mellitus, hypertension, pulmonary tuberculosis, and end-stage renal disease was previously treated with hemodialysis (HD). He received a kidney transplant and had a well-functioning graft for 2 years. He presented to our emergency department with gastric ulcer bleeding and received treatment involving an endoscopic submucosal epinephrine injection, a proton pump inhibitor, and blood transfusions. Nine days later, he complained of sudden lower abdominal pain and had acute anuric kidney failure. Renal ultrasonography revealed an absence of blood flow to the allograft kidney. Renal artery angiogram demonstrated complete occlusion of the transplanted renal artery. After thrombectomy and percutaneous transluminal angioplasty (PTA) with stent placement, 60% stenosis of the proximal renal artery with distal perfusion was noted. However, his graft function did not improve, and he received HD again. Histopathology of the transplanted kidney revealed ischemic tubular nephropathy with focal infarction without rejection.
  
  
  CONCLUSIONS
  This is the first case of acute thrombosis of the transplanted renal artery following gastric ulcer bleeding in a patient with a long-term well-functioning graft kidney.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital Institute of Clinical Medicine, National Yang-Ming University, Taipei Schoolof Medicine, Fu-Jen Catholic University, New Taipei City Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Chung-Kuan
authors.initials: CK
authors.lastname: Wu
authors.forename: Jyh-Gang
authors.initials: JG
authors.lastname: Leu
authors.forename: Cheng-Chun
authors.initials: CC
authors.lastname: Wei
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Hsieh
mesh_terms: D000208:Acute Disease; D000368:Aged; D064591:Allografts; D000792:Angiography; D017130:Angioplasty; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000150:complications* / Q000628:therapy; D012077:Renal Artery / Q000637:transplantation*; D006435:Renal Dialysis; D015607:Stents; D017131:Thrombectomy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy