Renal graft survival has improved over the past years, mainly owing to better immunosuppression. Vascular thrombosis, though rare, therefore accounts for up to one third of early graft loss. We assess current literature on transplantation, identify thrombosis risk factors, and discuss means of avoiding thrombotic events and saving thrombosed grafts. The incidence of arterial thrombosis was reported to 0.2–7.5% and venous thrombosis 0.1–8.2%, with the highest incidence among children and infants, and the lowest in living donor reports. The most significant risk factors for developing thrombosis were donor-age below 6 or above 60 years, or recipient-age below 5-6 years, per- or postoperative hemodynamic instability, peritoneal dialysis, diabetic nephropathy, a history of thrombosis, deceased donor, or >24 hours cold ischemia. Multiple arteries were not a risk factor, and a right kidney graft was most often reported not to be. Given the thrombosed kidney graft is diagnosed in time, salvage is possible by urgent reoperation and thrombectomy. Despite meticulous attentions to reduce thrombotic risk factors, thrombosis cannot be entirely prevented and means to an early detection of this complication is desirable in order to save the kidneys through prompt reoperation. Microdialysis may be a new tool for this. 1. Background In 1905, the first paper on kidney transplantation was published [1]. The French surgeon Alexis Carrel had, in the preceding years, developed techniques for vascular suture and anastomoses. In 1902, he transplanted a kidney from a small-size dog into its neck with the renal artery joined to the carotid artery and the vein to the external jugular vein. After three days, he noted a slightly greater blood flow than in the normal kidney and a urine production that was five times greater in the transplanted kidney. The animal died from an infection within few days. In 1912, Alexis Carrel received the Nobel Prize for his work. Fifty years after the pioneering experiments, the first successful human renal transplantation was carried out in Boston by Dr. Joseph Murray in 1954 [2]. The donor was the patient’s identical twin brother. Preceding the operation, monozygosity was confirmed by the successful exchange of a full thickness skin graft between the brothers. The transplanted kidney functioned for eight years until cardiac death of the patient. In the succeeding decades, a tremendous development has been taking place, with an increasing understanding of immunological aspects of transplantation and the opportunity for pharmacological
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