Reno-Portal Venous Drainage for a Cadaveric Renal Transplant in the Setting of Complete Absence of the Infrahepatic Inferior Vena Cava

Background: Kidney transplantation is the ideal treatment for end-stage renal disease. With diffuse thrombosis of the iliac veins and inferior vena cava, transplant surgeons face challenges. Case Report: We present a case of a 6-year-old female, with ESRD secondary to congenital nephrotic syndrome caused by dual heterozygous NPHS1 mutations, with a history of IVC thrombosis following central line placement. MRV confirmed total occlusion of the IVC and common iliac veins. Ultrasound confirmed patent hepatic vasculature. She underwent deceased donor kidney transplantation with reno-portal venous outflow without complications. Conclusions: It is essential for transplant surgeons to have outflow alternatives when dealing with patients who have complex vascular anatomy. This ensures proper venous drainage and reduces the risk of graft thrombosis. Preoperative surgical planning is crucial. Despite the technical difficulties, KT should always be considered for eligible patients. We believe there is value in presenting these challenging cases to new generations of transplant and pediatric surgeons who are not familiar with these alternatives.