MAY-THURNER SYNDROME COMPLICATING LEFT LOWER QUADRANT DECEASED DONOR KIDNEY TRANSPLANTATION IN ADULT POLYCYSTIC KIDNEY DISEASE

Introduction:

May-Thurner syndrome (MTS) is a rare anatomically and pathologically variable condition leading to venous outflow obstruction because of extrinsic venous compression in the ilio-caval venous territory. It can be asymptomatic, but chronic venous hypertension or venous occlusion can occur, with or without venous thrombosis. We report progressive MTS 2 months after a deceased donor kidney (DDK) transplant, causing ipsilateral left lower extremity edema and DDK dysfunction.

Methods:

A 43-yo male with ESRD due to ADPKD, on hemodialysis since March 2017 received a DDK in March 2024. Nine weeks post-transplant, he presented with new-onset unilateral left lower extremity swelling (Figure 1). Dopplers ruled out DVT but showed extrinsic compression of the left external iliac vein from the native left ADPKD kidney and left lower quadrant DDK resulting in a 75-99% narrowing of the vessel, consistent with May-Thurner Syndrome (Figures 2 & 3). DDK ultrasound with Duplex showed a 12.01 cm DDK, no renal allograft hydronephrosis and no evidence of renal artery stenosis. Serum creatinine, however, that was progressively trending down post-transplantation, had thereafter partially reversed this downward trend.

Results:

The patient subsequently underwent an open left native nephrectomy in May 2024. The left lower extremity swelling resolved and repeat Doppler examination of the ilio-caval venous system and the revealed resolution of the earlier observed extrinsic compression of the left external iliac vein. Serum creatinine has since stabilized at about 2.0 mg/dL.

Conclusions:

Our patient had May-Thurner syndrome with symptomatic ipsilateral left lower extremity edema following a left lower quadrant DDK implantation, with evidence of renal allograft dysfunction. To avoid further renal allograft compromise and to mitigate the lower extremity swelling, and to potentially avoid the risk of venous thrombosis, the patient successfully underwent an open native left nephrectomy. The left lower extremity has resolved and Doppler examination of the ilio-caval venous territory has normalized with no evidence of venous compression. DDK function has also since stabilized.

We have described the first case of May-Thurner syndrome post-renal transplantation. Our patient illustrated the importance of considering elective nephrectomy(ies) with very large ADPKD kidneys to avoid such complications and to avoid the need for repeated open surgical procedures.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.