RECURRENT VASCULAR THROMBOSIS IN AN ADOLESCENT TRANSPLANT RECIPIENT

Vascular thrombosis is one of the more difficult problems of pediatric renal transplantation; its etiology is multifactorial and, in most ca ses, it is irreversible. Vascular thrombosis accounts for 12.9% of gra ft failures in primary transplants in children and for 20% of graft fa ilures in repeat transplants. Although it is seen most often in very y oung recipients and in recipients of kidneys from young donors, it can manifest in older children and adolescents as well. The peak incidenc e is seen in the first 48 h after transplantation; however, the event may be delayed until after the first week. When thrombosis occurs in a n adolescent patient late in the course of transplantation, the pathog enesis is undetermined and immunosuppressive therapy is frequently imp licated. This article describes a 19-yr-old patient with a three-antig en-matched cadaveric kidney who received cyclosporine and anti-thymocy te globulin for induction. Vascular thrombosis occurred after 7 d of i nitial good function. Eventually the graft was removed after attempts to re-establish vascularization failed. The patient received a second graft and despite an optimal six-antigen-match and different immunosup pression with tacrolimus, thrombosis recurred by the fifth postoperati ve day. The discussion that follows reviews the incidence and the fact ors implicated in the pathogenesis of this entity.