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Published on: February 2, 2021
Aortic Dissection and Severe Renal Failure 6 Years After Kidney Transplantation
Amaury Dujardin1, Awena Le Fur2, Diego Cantarovich1
1Department of Nephrology, Institute of Transplantation, Urology and Nephrology, Nantes University Hospital, Nantes, France.
Insights
A kidney transplant patient experienced graft failure due to aortic dissection, a rare complication. Management involved blood pressure control, anticoagulation, and reduced immunosuppression, leading to graft recovery and dialysis cessation.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Kidney transplantation is a common treatment for end-stage renal disease.
- Hypertension is a significant risk factor for kidney disease and cardiovascular complications.
- Graft failure can occur due to various factors, including cardiovascular events.
Purpose of the Study:
- To report a rare case of kidney graft failure secondary to Stanford B aortic dissection.
- To discuss the management and outcomes of aortic dissection in a kidney transplant recipient.
- To highlight the potential impact of immunosuppression on cardiovascular health post-transplantation.
Main Methods:
- Case report of a kidney transplant recipient with long-term hypertension.
- Diagnosis of aortic dissection via contrast-enhanced computed tomography.
- Management included hemodialysis, blood pressure control, oral anticoagulation, and modified immunosuppression.
Main Results:
- The patient presented with neurological symptoms and graft failure, initially attributed to other causes.
- Stanford B aortic dissection involving multiple arteries was diagnosed.
- Conservative management with reduced immunosuppression led to graft recovery and cessation of dialysis.
Conclusions:
- Stanford B aortic dissection can present atypically in kidney transplant recipients, leading to graft dysfunction.
- Conservative management, including blood pressure control and anticoagulation, can be effective.
- Reducing immunosuppression may aid in recovery and graft survival in such complex cases.
Abstract:
We report the case of a patient with long-term history of hypertension, presenting with transient neurological disorders and severe graft failure several years after kidney transplantation. Cause of end-stage renal disease was hypertensive nephrosclerosis. Chronic hemodialysis lasted for 1 year. After transplantation and throughout follow-up, serum creatinine ranged from 200 to 230 μmol/L and maintenance immunosuppression included sirolimus and low-dose steroids. Six years after transplantation, the patient presented with right hip pain radiating to the lower back, transient aphasia, confusion, and hemiparesis. Surprisingly, progressive anuria was established requiring dialysis. After numerous nonconclusive investigations including renal histology, a contrast computed tomography scan discovered a Stanford B aortic dissection from the left common carotid artery and left subclavian artery to bilateral internal and external iliac arteries, including the right femoral artery. No surgical treatment was opted and hemodialysis, tight control of blood pressure and oral anticoagulation were established. Immunosuppression was lightened to low-dose steroids alone. After 8 months, chronic dialysis was stopped, and today, 22 months after the diagnosis of aortic dissection, the patient is doing well with a still functioning graft (creatinine, 377 μmol/L; modification of diet in renal disease-glomerular filtration rate, 15 mL/min), and without any other immunosuppression than low-dose steroids.
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