Biopsy Induced Arteriovenous Fistula and Venous Stenosis in a Renal Transplant

Sridhar R Allam,Tom S Livingston,Balamurugan Sankarapandian,Patrick C Nef,Imran A Memon,George Rofaiel

doi:10.1155/2015/313610

Sridhar R Allam, Tom S Livingston + Show 4 more

Open Access

https://doi.org/10.1155/2015/313610

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Abstract

Renal transplant vein stenosis is a rare cause of allograft dysfunction. Percutaneous stenting appears to be safe and effective treatment for this condition. A 56-year-old Caucasian female with end stage renal disease received a deceased donor renal transplant. After transplant, her serum creatinine improved to a nadir of 1.2 mg/dL. During the third posttransplant month, her serum creatinine increased to 2.2 mg/dL. Renal transplant biopsy showed BK nephropathy. Mycophenolate was discontinued. Over the next 2 months, her serum creatinine crept up to 6.2 mg/dL. BK viremia improved from 36464 copies/mL to 15398 copies/mL. A renal transplant ultrasound showed lower pole arteriovenous fistula and abnormal waveforms in the renal vein. Carbon dioxide (CO2) angiography demonstrated severe stenosis of the transplant renal vein. Successful coil occlusion of fistula was performed along with angioplasty and deployment of stent in the renal transplant vein. Serum creatinine improved to 1.5 mg/dL after.

Highlights

Renal transplant vein stenosis is a rare cause of allograft dysfunction
Patient was given oral anticoagulation combined with antiplatelet therapy Aspirin 81 mg daily for 6 months after the procedure followed by longterm administration of Aspirin 325 mg daily. This patient’s course is consistent with biopsy induced arteriovenous fistula that likely led to renal vein stenosis in the allograft
Progressive rise in serum creatinine despite improvement in BK viremia/nephropathy, extensive interstitial edema on biopsy that is indicative of venous outflow obstruction, and prompt improvement in allograft function following renal vein stenting support venous stenosis as the predominant etiology of her allograft dysfunction

Summary

Introduction

Renal transplant vein stenosis is a rare cause of allograft dysfunction. It can result from damage to the vein during organ procurement or from surgical complications like hematoma, lymphocele, or torsion of renal vein. Other reported etiologies include allograft rejection [1], renal vein thrombophlebitis from adjacent infected fluid collection [2], high-pressure turbulent flow in the presence of arteriovenous fistula in the renal allograft [3], external compression from the crossing iliac artery [4], preexisting renal vein stenosis in the donor kidney [5], or idiopathic [6]. Renal transplant vein stenosis should be considered in the differential diagnosis of unexplained allograft dysfunction. We report a case of biopsy induced arteriovenous fistula that led to renal transplant vein stenosis and allograft dysfunction

Case Presentation

Discussion