Kidney Transplantation and Renal Vascular Issues

Kidney transplantation offers superior survival and quality of life for patients with end-stage kidney disease (ESKD) compared to dialysis. However, vascular complications remain a significant concern, impacting graft survival and transplant success. This chapter explores perioperative vascular considerations, focusing on complications such as transplant renal artery stenosis (TRAS), renal artery thrombosis, renal vein thrombosis, and other vascular injuries. Vascular complications, including stenosis and thrombosis, occur in 3–23% of kidney transplant patients. The left donor kidney is typically preferred due to anatomical advantages, though using the right kidney can increase thrombotic risks. Hemorrhagic complications from antithrombotic agents or induction therapies can range from minor hematomas to severe hemorrhagic shock, potentially leading to antibody-mediated rejection. Renal vein thrombosis, occurring in 0.5–4% of cases, often results from mechanical issues or extraluminal compression, requiring emergent Doppler ultrasound for diagnosis. Renal artery thrombosis, occurring in 0.5–3.5% of cases, typically presents within the first month post-transplant, necessitating surgical revascularization or thrombolytic therapy. TRAS, with an incidence of 1–23%, significantly impacts graft survival and patient outcomes. Treatment options include medical therapy, endovascular approaches, and surgical revascularization, with percutaneous transluminal angioplasty often preferred. Maintaining vascular health could enhance graft survival in kidney transplant recipients, requiring a comprehensive, multimodal treatment approach.