title: Immediate Vascular Complications After Kidney Transplant: Experience from 2100 Recipients.
abstract: OBJECTIVE
  Vascular complications, especially immediate events during kidney transplant, are the major cause of graft loss, and prompt surgical intervention is important for salvage of the graft and recipient. In this study, our aim was to show our experiences with vascular interventions and their effects on graft outcomes in transplant patients with suspected immediate vascular events.
  
  
  METHODS
  Over 24 years (from 1990 to 2014), 2100 renal transplant procedures (1562 living and 538 deceased donors) were performed by one fixed team. We reviewed the recipients to find cases with immediate vascular complications, including artery or vein kinking or torsion, renal artery thrombosis, and renal vein thrombosis. Diagnosis of a vascular event was suspected when urinary output suddenly stopped and was confirmed by color Doppler ultrasonography or immediate exploration. Characteristics of the patients and events, surgical interventions for saving grafts, and graft outcomes were assessed.
  
  
  RESULTS
  Our study included 28 vascular accidents (1.3% of total renal transplants). Arterial kinking or torsion, venous kinking or torsion, renal artery thrombosis, and renal vein thrombosis occurred in 11 (0.52%), 2 (0.09%), 12 (0.57%), and 3 patients (0.14%). Nine of the 11 cases of arterial kinking occurred with use of internal iliac artery. Eleven of 13 grafts with vascular kinking or torsion were saved by immediate surgical intervention, but only 4 grafts in patients with renal artery thrombosis and only 1 graft in patients with renal vein thrombosis were saved by surgical intervention. Delayed graft function occurred in all cases of saved renal artery and renal vein thrombosis but only in 5 cases (4 arterial and 1 venous) of vascular kinking or torsion.
  
  
  CONCLUSIONS
  The incidence of immediate vascular complications was 1.3% in our study. Sudden cessation of urine after renal transplant is a warning sign, and immediate diagnosis of vascular events will help salvage the graft with proper intervention.
authors.affiliation: From the Urology Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Tavakkoli
authors.forename: Reza Mahdavi
authors.initials: RM
authors.lastname: Zafarghandi
authors.forename: Rahim
authors.initials: R
authors.lastname: Taghavi
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghoreifi
authors.forename: Masoud Mahdavi
authors.initials: MM
authors.lastname: Zafarghandi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D051799:Delayed Graft Function / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014563:Urodynamics; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult