Renal artery thrombosis is a rare complication in transplantation that is more common in kidneys with donor vascular disease or with multiple vessels requiring bench surgery before transplantation. It is also common in kidneys from paediatric en bloc donors. Other possible causes include persistent hypotension, dehydration, and procoagulant conditions (e.g., lupus anti-coagulant and diabetes). It can be an acute event postoperatively or up to a few months postoperatively. Reasons for early arterial thrombosis are usually technical. Fine vascular suture materials should be used for the anastomosis. We usually use 5/0 Prolene for the vein and 6/0 Prolene for the artery. If the allograft does not perfuse properly the vascular clamps are re-applied, the kidney flushed with cold perfusion solution, and the anastomosis redone. In delayed arterial thrombosis salvage is rarely possible. The patient may experience severe pain, swelling, or severe haema-turia. There may be cessation of urine output or an episode of severe rejection. Thrombosis can be identified with Doppler and allograft nephrectomy is usually required.
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