Introduction: Atresia or obliteration of the inferior vena cava (IVC) is considered to be the main reason to refuse kidney transplantation (KTx) in kids for technical problems or impossibility KTx the venous blood outflow of graft that creates a significant increase in the risk of kidney transplant thrombosis. Previous surgical interventions on the abdominal organs and retroperitoneal space, prolonged presence or repeated insertion of a dialysis catheter into the lumen of the iliac veins and inferior vena cava, as well as congenital anomalies of the venous arteries can lead to absolute venous obstruction or obliteration.
Materials and methods: The study included 5 cases of KTx in children with atresia or IVC obliteration during the period from September 2018 to May 2023. The age of the patients was from 1 to 5 years, body weight - from 7.8 kg up to 18.2 kg. Among 5 KTx were from adult kidney donors, one was living related and 4 grafts were from a deceased donor. Before transplantation all patients underwent multispiral CT scanning to visualize vessel architecture of the abdominal region of the aorta and iliac arteries, as well as IVC and iliac veins if any to determine the expected zone of vascular anastomosis formation. The follow-up period for patients ranged from 2 to 60 (25.4 ± 22.6) months.
Results: The kidney graft in all cases was placed intraperitoneally to perform a venous anastomosis with an accessible area of the subhepatic part of the IVC. The right kidney was transplanted after lengthening of the grafts van with the donor part of the IVC. In two cases, a left kidney from a deceased donor was used, which did not require vein reconstruction. In one case, transplantation of the left living related kidney did not require vascular reconstruction. In all the presented cases, the direct function of the graft was obtained through CT scanning. There were no complications in the early and late postoperative period.
Conclusion: Despite the high surgical risks, kidney transplantation to children with atresia or obliteration of the inferior vena cava is a life-saving operation when it is impossible to create adequate access for kidney replacement therapy. Comprehensive examination and careful planning of surgical intervention, as well as preventive measures in the postoperative period, reduce the risk of vascular complications, which has a positive effect on the results of kidney transplantation, and the presence of impaired IVC is not a contraindication to kidney transplantation in children.