Successful renal retransplantation after structured optimization in a patient with diffuse systemic venous thrombosis and complex urological pathology: a case report

Renal retransplantation in the presence of extensive systemic venous thrombosis, lack of reliable vascular access and complex lower urinary tract pathology presents significant challenges. We report a 27-year-old male who presented for kidney retransplantation following chronic rejection of a previous graft. Pretransplant evaluation revealed extensive thrombosis involving central and peripheral venous systems, pericatheter thrombosis of a left femoral dialysis line, burn injury to the trunk, bilateral upper limbs and right lower limb, a previous gunshot injury to the right thigh, volume overload with dyselectrolytemia, panurethral stricture and infected allograft from first transplant. These challenges were approached stepwise by a multidisciplinary team. Peritoneal dialysis was initiated due to complexity in vascular access, and urethral reconstruction using buccal mucosal graft urethroplasty was performed to ensure a good urinary outflow tract along with transplant nephrectomy of the infected graft. The patient received desensitization therapy for donor-specific antibodies and positive crossmatch and orthotopic renal transplantation was performed after native left nephrectomy (due to extensive bilateral iliac vein thrombosis). The patient had excellent postoperative recovery with good allograft function. This case highlights the importance of careful multidisciplinary planning and staged approach for a successful renal retransplantation even in complicated clinical scenarios.