Acute graft thrombosis in a patient with factor V Leiden mutation: A case report and review of literature

BACKGROUND: Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss. Prompt diagnosis and intervention are essential, particularly in patients with inherited thrombophilias such as factor V Leiden (FVL) mutation. CASE SUMMARY: A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis. The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries. Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution. Reperfusion was successful with immediate urine output and gradual improvement in renal function. The patient was discharged on direct oral anticoagulation therapy. CONCLUSION: Early detection and surgical intervention can preserve graft function in post-transplant renal artery thrombosis even in patients at high risk.