A successful case of salvage kidney transplantation using the recipient gonadal vein to bypass a major outflow obstruction

Renal transplantation is the treatment of choice for chronic kidney disease and has been shown to have better outcomes than dialysis in multiple studies.1 In the standard procedure, the donor renal artery and vein are anastomosed to the external iliac vessels of the recipient. In cases of an unusable vein, such as thrombosis of the iliac vein or inferior vena cava (IVC), renal transplantation becomes extremely difficult. These issues were originally considered contraindications to renal transplant, but several case reports have demonstrated ways to circumvent the obstructed veins by using other systemic or portal veins in the area. We present an unusual case of kidney transplantation on a right external iliac vein (EIV) that contained a chronic thrombus extending to the common iliac vein (CIV) and infrarenal IVC, hence, partially obstructing the right EIV. It was identified intraoperatively after a standard initial anastomosis. The transplanted kidney was salvaged by utilizing the recipient right gonadal vein to bypass the iliac outflow obstruction.