title: Successful Renal Transplantation in Small Children With a Completely Thrombosed Inferior Vena Cava.
abstract: In small children with end-stage renal disease, an adult-sized kidney transplant is the best option. However, in the face of a completely thrombosed inferior vena cava (IVC), such transplants can be challenging, given the difficulty of achieving adequate renal venous outflow and the risk of graft thrombosis. Using a new technique to anastomose the renal vein to the right hepatic vein/IVC junction, we successfully implanted an adult-sized graft in two small children (9.8 and 14 kg) who had end-stage renal disease and a completely thrombosed IVC. After mobilizing the right lobe of the liver and obtaining total vascular occlusion of the liver, we used a Fogarty catheter to dilate the retrohepatic IVC. In the right hepatic vein, we made a venotomy and extended it inferiorly onto the retrohepatic IVC. To that venotomy, we anastomosed the donor left renal vein, using continuous 7-0 Prolene sutures. Both patients attained excellent renal allograft function: One had a serum creatinine level of 0.30 mg/dL at 6 mo after transplant, and the other had a level of 0.29 mg/dL at 1 year. In these two small children with completely thrombosed IVC, our technique for transplanting an adult-sized kidney provided adequate venous outflow.
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: P
authors.initials: P
authors.lastname: Verghese
authors.affiliation: Department of Surgery, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: E
authors.initials: E
authors.lastname: Minja
authors.affiliation: Department of Surgery, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: V
authors.initials: V
authors.lastname: Kirchner
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: B
authors.initials: B
authors.lastname: Chavers
authors.affiliation: Department of Surgery, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: A
authors.initials: A
authors.lastname: Matas
authors.affiliation: Department of Surgery, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: S
authors.initials: S
authors.lastname: Chinnakotla
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D011379:Prognosis; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery*
keywords: clinical research/practice; complication: surgical/technical; kidney transplantation/nephrology; kidney transplantation: living donor