Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome

Padilla, Paola Karina García; Afanador, D. Pardo; González, C.; Yucumá, Daniela; Uribe, Jorge; Romero, Alejandro

doi:10.1016/j.transproceed.2020.01.051

Cited by 4 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Symptoms on average begin within 6 months after graft failure and include fever, hematuria, anemia, and localized pain at the graft site. [2] Gradual immunosuppression weaning or continued low dose immunosuppressive therapy may suppress graft intolerance syndrome; however, in one single-center study, immunosuppression weaning led to a seven-fold risk (P = 0.017) for admission within 6 months of graft failure with symptomatic rejection. [3] Many patients on continued low-dose immunosuppression are also at increased risk for metabolic disorders (diabetes, hypertension, and dyslipidemia), infection, cardiovascular complications, and malignancies including skin cancer and non-Hodgkin's lymphoma.…”

Section: Discussionmentioning

confidence: 98%

“…[ 1 ] Given that renal allograft failure increases year over year and roughly 40% will go on to develop graft intolerance syndrome, alternative methods of treatments to improve outcomes should be more closely evaluated. [ 2 ] Conventional methods of treatment, including low-dose immunosuppression therapy and transplant nephrectomy, have an increased incidence of complications. Minimally invasive transarterial embolization, although described sparingly in the literature for graft intolerance syndrome, should be more heavily considered as a first-line treatment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of failed renal allograft embolization in the treatment of graft intolerance syndrome

Hindi

Harb

2023

JCIS

View full text Add to dashboard Cite

Nearly, 20% of renal allografts fail after 5 years resulting in a return to hemodialysis. These patients subsequently undergo withdrawal of immunosuppressant therapy, and the failed allograft is left in situ. However, many patients (40%) develop graft intolerance syndrome, characterized by fever, pain, and hematuria. Conventionally, this is managed with low-dose maintenance immunosuppressant therapy, however, that is not without notable adverse risk. In refractory patients, transplant nephrectomy is the treatment of choice; however, this caries significant morbidity and mortality. Interventional radiology plays a substantial role of treating graft intolerance syndrome while delivering improved patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Role of failed renal allograft embolization in the treatment of graft intolerance syndrome

Hindi

Harb

2023

JCIS

View full text Add to dashboard Cite

show abstract

“…A retrospective cohort study showed that older donor age, shorter graft survival, and the number of rejections can be used to predict the need for graft nephrectomy [29]. Recently, renal graft embolization was shown to be an effective technique as an alternative treatment strategy in patients with clinical signs of intolerance syndrome, with a success rate >80%, low morbidity, and short hospital stay [28,30]. For our patient, allograft nephrectomy was postponed in the setting of active pemphigoid to a time when her skin condition improved.…”

Section: A B Cmentioning

confidence: 99%

Levofloxacin-Associated Bullous Pemphigoid in a Hemodialysis Patient After Kidney Transplant Failure

2022

View full text Add to dashboard Cite

Objective:Rare disease Background:Patients with end-stage renal disease (ESRD) who require dialysis can develop a variety of skin conditions, such as pruritus, xerosis, skin infections, and autoimmune reactions. Bullous pemphigoid (BP) is an autoimmune bullous disorder with an increasing incidence. It can be caused by over 90 medications, but levofloxacin-induced BP in hemodialysis patients has not yet been reported. This report is of a 27-year-old woman with ESRD on hemodialysis who developed BP after levofloxacin treatment. Case Report:A 27-year-old woman with hemodialysis after kidney transplantation failure was started with levofloxacin for suspected urinary tract infection 1.5 months prior to admission. Her urinary tract infection symptoms were improved after 3 weeks of levofloxacin treatment, but a serious rash developed, presenting with progressive bullous throughout the body and facial involvement. A thorough workup showed a remarkably elevated hemidesmosomal antigen, BP180 (116 RU/mL), and cutaneous indirect immunofluorescence on human salt-split skin substrate was positive for serum basement membrane zone IgG with an epidermal pattern. Skin biopsy direct immunofluorescence staining showed continuous linear C3 deposition along the basement membrane zone. Prednisone 60 mg daily was started with a taper schedule. She no longer had new skin rash during a followup of over 3 months. Conclusions:To the best of our knowledge, this is the first case of levofloxacin-induced BP in a patient undergoing hemodialysis. This report highlights the importance of recognizing skin reactions associated with ESRD in dialysis patients, the correct diagnosis by biopsy and histopathology, and the correct and timely management.

show abstract

“…Es de tener en cuenta que el trasplante fallido puede causar síntomas que dan paso al síndrome de intolerancia del injerto, el cual tiene una incidencia de hasta un 40 % [8][9][10][11] en los pacientes con falla del trasplante y principalmente durante el primer año de iniciada la diálisis. Este síndrome clínico es caracterizado por dolor o edema del injerto, hematuria, ebre o malestar [12], como producto de un estado in amatorio reactivo [5] que obedece a la respuesta inmunológica ante la presencia del riñón fallido [13].…”

Section: Introductionunclassified

“…Por ejemplo, en un metaanálisis con 189 casos de embolización transcatéter no se presentaron lesiones vasculares asociadas [19]. Del mismo modo, a nivel nacional, una serie de 12 casos publicados tampoco documentaron este tipo de complicación [9].…”

Section: Introductionunclassified

Embolización transcatéter del injerto renal en pacientes con síndrome de intolerancia: reporte de tres casos en un grupo de trasplantes

Taboada

Cabellero-Tovar

Jaramillo

et al. 2022

Rev. Colomb. Nefrol.

View full text Add to dashboard Cite

Introducción: el síndrome de intolerancia es un proceso inflamatorio que ocurre hasta en un tercio de los pacientes con pérdida del injerto. Cuando no se obtiene una mejoría de los síntomas con el manejo médico, se indica la realización de nefrectomía del riñón trasplantado, sin embargo, este es un procedimiento invasivo que puede estar asociado a mayor morbilidad y mortalidad. Dada la fragilidad de estos pacientes, se plantea la embolización transcatéter del injerto como una alternativa válida y menos invasiva para el tratamiento de este síndrome. Objetivo: describir el uso de la embolización transcatéter como tratamiento al síndrome de intolerancia del injerto. Presentación del caso: se reportan tres casos clínicos de pacientes con sintomatología de entre 15 y 20 días de evolución, consistentes en dolor y tumefacción sobre riñón trasplantado y otros signos y síntomas reportados fueron fiebre, hiporexia, pérdida de peso y hematuria macroscópica. Se describe la evolución de los síntomas que en ninguno de los casos expuestos tuvieron mejoría con el ajuste inmunosupresor, descartando en todos los casos etiología infecciosa y estableciéndose así la sospecha síndrome de intolerancia del injerto. Los pacientes fueron manejados con embolización transcatéter de la arteria del riñón trasplantado y el éxito del tratamiento se definió por la resolución de los síntomas. Discusión y conclusión: entre las primeras 24-48 horas posprocedimiento, los pacientes presentaron una evolución satisfactoria y, finalmente, egreso. La embolización transcatéter del injerto es una alternativa segura a la nefrectomía del trasplante y que es menos invasiva para el tratamiento del síndrome de intolerancia del injerto.

show abstract

Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome

Cited by 4 publications

References 20 publications

Role of failed renal allograft embolization in the treatment of graft intolerance syndrome

Role of failed renal allograft embolization in the treatment of graft intolerance syndrome

Levofloxacin-Associated Bullous Pemphigoid in a Hemodialysis Patient After Kidney Transplant Failure

Embolización transcatéter del injerto renal en pacientes con síndrome de intolerancia: reporte de tres casos en un grupo de trasplantes

Contact Info

Product

Resources

About