Successful Renal Transplantation in Small Children With a Completely Thrombosed Inferior Vena Cava

In small children with end‐stage renal disease, an adult‐sized kidney transplant is the best option. However, in the face of a completely thrombosed inferior vena cava ( IVC ), such transplants can be challenging, given the difficulty of achieving adequate renal venous outflow and the risk of graft thrombosis. Using a new technique to anastomose the renal vein to the right hepatic vein/ IVC junction, we successfully implanted an adult‐sized graft in two small children (9.8 and 14 kg) who had end‐stage renal disease and a completely thrombosed IVC . After mobilizing the right lobe of the liver and obtaining total vascular occlusion of the liver, we used a Fogarty catheter to dilate the retrohepatic IVC . In the right hepatic vein, we made a venotomy and extended it inferiorly onto the retrohepatic IVC . To that venotomy, we anastomosed the donor left renal vein, using continuous 7‐0 Prolene sutures. Both patients attained excellent renal allograft function: One had a serum creatinine level of 0.30 mg/ dL at 6 mo after transplant, and the other had a level of 0.29 mg/ dL at 1 year. In these two small children with completely thrombosed IVC , our technique for transplanting an adult‐sized kidney provided adequate venous outflow.