Successful renal transplant in iliac vein thrombosis - case report

Background Renal transplant is commonly placed in the right iliac fossa. The external iliac veins are the standard site of graft vein anastomosis. We report a rare case scenario where a patient with bilateral iliac vein thrombosis underwent an orthotopic renal transplant. We used an unorthodox technique to overcome this difficulty. Case presentation A 43 year old male with chronic kidney disease on maintenance hemodialysis was found to have bilateral iliac vein thrombosis on workup for a renal transplant. The patient also had inferior vena cava thrombosis. The patient underwent an orthotopic renal transplant. Initially, a native left nephrectomy was done. The graft, which was a right donor kidney, was anastomosed in a novel way. The graft vein was anastomosed to the native left renal vein. The graft artery was anastomosed to the native aorta. The graft was placed in the left lumbar region. Outcome The transplant was uneventful. The serum creatinine and the urine output were satisfactory on discharge, at one and after nine months of follow up. This was not just a rare case, it was a problem solving surgical case with good outcome.