Allograft renal vein thrombosis is an uncommon but serious complication of renal transplantation. It usually occurs early after surgery but still it can occur at any time. *Mechanical factors (compression by haematoma, lymphocele,abscess -extension of ipsilatenal dvtkinking or angulation of renal vein) remain the most common aetiological factors. severe early rejection (especially vascular rejection), haemostatic defects are well known factors, rare causes like cyclosporine, ischaemic injury of venous wall are also reported *the symptoms are non specific: Haemaluria, proteinuria, sudden drop of uop, rise of s.creatinine, diagnosis is often delayed because of the non specific features and usg,renogram findings may resemble acute rejection or atn *early diagnosis and subsequent intervention gives the only hope to sahvage these allografts.
Materials, methods: The files of 680 recipients transplated from 1993 in organ transplant center in kuwait were revised, seven incidents of r.v.t were recorded (biopsy-proven). Three were due to compoession by haematoma and one due to rejection and no obvious cause could be found in the remaining. Four allografts were removed and three could be salvaged by early surgical intervention, two of these fortunate patients are still dialysis free so far (4 years, 6 months). The incidence of rvt in our series is 1% we could salvage three cases of r.v.t by alert monitoring, early effective intervention. In the first case the patient was found to have a serious decline of uop in the day of operation after initial good dieuresis. Urgent renogram showed almost no perfusion of the allograft. Within 2 hours he was eaplored, perigraft haematoma evacuated, vasc. Anastomosis undone allograft reperfused, retransplanted, currently his s.creat. Stabilised around 350, with lower polar infarction since 2002. The second patient developed haematuria, oliguria on the 5th p.o day. Renogram showed no perfusion, exploration revealed r.v.t, the kidney was revascularised with implantation of a vein graft. the kidney was reperfused, biopsy showed rejection, she remianed in atn for 3 months and we had to remove this kidney. In the 3rd patient, the incident was in the 2nd p.o day when he developed haematuria, oliguria, renogram showed a delayed perfusion most propably 2ry to rvt, within 2 hours he was explored, no abnormality could be found except that the kidney was swollen, dusky, picked up soon after opening the wound. He’s dialysis free for 6 months so far, with s. creat. 500 biopsy showed atn. conclusion: r.v.t is a grave complication of r.tx., early diagnosis, intervention are the secrets of salvage. Mechanical causes are the most vulnerable to surgical correction. Early severe vascular rejection is a serious complication that my lead to r.v.t.