Capd-Related Peritonitis After Renal Transplantation
Yükleniyor...
Dosyalar
Tarih
2010
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Multimed Inc
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
We admitted a 53-year-old male for deceased-donor kidney transplantation. He had been on continuous ambulatory peritoneal dialysis (CAPD) for 52 months. His native kidney disease was unknown. He was doing well on CAPD and had never experienced peritonitis. We did not have a measurement of panel reactive antibodies prior to his transplant surgery. The kidney was placed into the right inguinal fossa and his peritoneal dialysis (PD) catheter was left in place. Since he was thought to be immunologically high risk, we administered rabbit antithymocyte globulin (ATG) at a dose of 3 mg/kg body weight as an induction agent, along with 1 g methylprednisolone and mycophenolate mofetil. No surgical complications occurred; however, his urine output was not adequate. Doppler ultrasound ruled out urinary tract obstruction and renal vein thrombosis. Tc-99m DTPA scintigraphy revealed a normally perfused kidney but concentration and excretion were diminished considerably. Percutaneous allograft biopsy was consistent with acute humoral rejection. We instituted 3 days of pulse prednisolone (1 g daily) along with alternate-day double-filtration (cascade) plasmapheresis, daily ATG, and mycophenolate mofetil. During the course of hospitalization, PD was resumed due to uremia. White blood cell (WBC) counts were followed and were typically below 100/mm3. Despite rigorous antirejection therapy, urine output remained below 15 mL per hour. Because of significantly reduced lymphocyte counts, we withheld ATG. Twelve days after transplantation, the patient complained of severe extensive abdominal pain. Peritoneal effluent was cloudy and total effluent WBC count was 27 × 103/mm3, with 75% polymorphs. His abdominal pain was very variable in severity. He did not develop fever. Broad-spectrum antibiotics were started promptly on an empirical basis. Cultures of the peritoneal effluent showed Acinetobacter baumanii sensitive only to aminoglycosides and tigecycline. Tigecycline was given intravenously as 100 mg initial dose then 50 mg twice daily. Despite an initial response, the patient died on the 17th day after transplantation due to refractory septic shock.
Açıklama
Anahtar Kelimeler
Capd-related peritonitis, Capd, Renal transplantation
Kaynak
Peritoneal Dialysis International
WoS Q Değeri
Q3
Scopus Q Değeri
Q2
Cilt
30
Sayı
Künye
Solak, Y., Atalay, H., Polat, İ., Yeksan, M., (2010). Capd-Related Peritonitis After Renal Transplantation. Peritoneal Dialysis International, (30), 596-599. Doi: 10.3747/pdi.2009.00169
