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A stormy transplant case with happy ending
1Department of Surgery, Gazi University School of Medicine, Ankara, Turkey.
International Urology and Nephrology
|July 17, 1999
Summary
This case study details a pediatric renal transplant patient who experienced severe rejection and a urinary fistula. Despite complications, the patient achieved excellent renal function post-treatment.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Urology
Background:
- A 12-year-old female with end-stage renal failure due to reflux nephropathy underwent augmentation cystoplasty for a contracted bladder.
- She subsequently received a kidney transplant from her father.
Observation:
- The patient experienced a severe rejection episode on postoperative day 4, requiring steroid and anti-thymocyte globulin (ATG) treatment.
- A urinary fistula developed, necessitating a second surgery on postoperative day 14 involving apical resection, omentoplasty, nephrostomy, and DJ stent replacement.
Findings:
- The post-second surgery period was challenging, marked by numerous complications for the patient and the medical team.
- Despite the difficulties, the patient was discharged on postoperative day 40 with normalized renal function, indicated by a serum creatinine level of 1 mg/dl.
Implications:
- This case highlights the complex management of pediatric renal transplant recipients facing severe rejection and surgical complications.
- Successful outcomes are achievable even after significant post-transplant challenges, emphasizing the importance of persistent medical and surgical intervention.
- The case underscores the critical role of multidisciplinary care in managing pediatric end-stage renal disease and transplantation.