Can Transplantation of Kidney from Living Related Donor with Both-sided Double Renal Arteries to Adpkd Patient Allergic to Muscle Relaxant Succeed? – A Case Study

Abstract: 55-year old man (BMI = 32) with ESRD caused by ADPKD was qualified to kidney transplantation. His 63 years old sister (BMI = 24, GFR = 97 ml/min/1.73 m2 and both-sided double renal arteries) volunteered to be an organ donor. In the half of March 2014, open nephroureterectomy procedure was performed. Left kidney was prepared and ureter was cut out. Then, transplant recipient revealed anaphylactic shock during induction of his general anaesthesia. Donors ureter was reconstructed by end-to-end repair. The diagnosis of recipient’s allergy to the antibiotic was suspected. A month later, second try of transplantation was performed. At those time, ciprofloxacin instead of ceftriaxone was administered for the recipient, however symptoms of the anaphylactic shock occurred again. Further diagnostic tests for anaesthetic agents showed positive intradermic allergy tests with cisatracurium. Next month, third try of kidney transplantation was organized and pancuronium was administered for skeletal muscles relaxation. Recipient anaelgesia underwent without any complications. The kidney was successfully procured despite of some postinflammatory adhesions over the kidney and ureter due to the previous surgery. Both renal arteries were attached separately end-to-side each one to recipient’s iliac external arteries. The diuresis of the recipient started in few days after transplantation, but serum creatinine concentration still estimates above 6 mg/dl, with CKD-EPI GFR in the range of 10-15 ml/min/1,72 m2 . Three years later, patient does not require any renal replacement therapy and does not have to conduct fluid restriction. The donor remains under regular follow-up care. The donor’s serum creatinine concentration of the is 1.3 mg/dl. Despite of GFR estimated at 40 ml/min/1.73 m2 , the donor has no complains, does not require any special treatment and declares no regrets of decision to kidney donation.

Authors:

Magdalena Kwapisz, Rafal Kieszek, Kalina Jedrzejko, Monika Bieniasz, Magdalena Nita, Marta Serwanska–Swiętek, Magdalena Durlik, Artur Kwiatkowski

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