Analysis of Vascular Complications After Renal Transplantation

Purpose. Despite medical and surgical advances, vascular complications remain common after renal transplant, occurring among 3%-15% of patients. These complications may compromise graft function. This study sought to evaluate the frequency and management of vascular complications after renal transplant. Materials and Methods. We retrospectively analyzed the 1843 transplantations performed at 2 centers by our team since November 1975. The 1349 male and 494 female patients had an overall mean age of 31.5 +/- 11.2 years; (range, 3-66). Grafts were obtained from a living-related donor in 1406 (76.29%) or a deceased donor in the remaining 437 (23.71%). The mean donor age was 40.7 +/- 13.7 years (range, 2-76). Of 1843 transplants, multiple vascular anastomoses were performed in 155 cases (8.4%), including 130 involving renal arteries and 25 renal veins. Results. Forty-seven vascular complications (2.55%) were observed in 43 procedures (2.33%), most frequently renal artery stenosis (n = 14). It was followed by allograft renal artery kinking (n = 7), renal vein kinking (n = 7), renal artery thrombosis (n = 5), renal vein laceration (n = 4), renal artery laceration (n = 3), renal vein thrombosis (n = 2), renal artery disruption (n = 2), renal and iliac vein obstructions owing to pressure from a lymphocele (n = 1), renal artery and vein obstruction owing to pressure from a hematoma (n = 1), or an arteriovenous fistula after percutaneous graft biopsy (n = 1). Fifteen of these 47 complications were treated by interventional radiologic procedures. Conclusion. The vascular complication rates in our patients were somewhat lower than those reported in the literature. A thorough understanding of how complications impair allograft function and survival is essential for adequate treatment. Interventional radiology is invaluable in the postoperative management of transplant-related complications.