A thirty-year-old Chinese man with a history of severe trauma to his right eye, with secondary sectoral aniridia and multiple operations including intraocular lens insertion more than fifteen years ago, underwent an uneventful Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) for his pseudophakic bullous keratopathy in a tertiary hospital in Hong Kong. The nature of his previous operations was unknown to the surgeon at the time of transplant. On postoperative day one, the graft was not present in the anterior chamber. Fundal view was limited because of corneal oedema. B-scan ultrasonography could not detect any definite presence of a donor button in the posterior segment as gas was present in the vitreous cavity. The patient was instructed to lie prone full time, and on postoperative day three, the graft was found to be reattached to the stroma with spontaneous resolution of corneal oedema, indicating restoration of pump function of endothelium graft. This is the first case of spontaneous reattachment of a posteriorly dislocated endothelial graft without surgical intervention or abandonment of the grafted endothelial button.

Ka Wai Kam

Alvin L. Young

Spontaneous Reattachment of a Posteriorly Dislocated Endothelial Graft: A Case Report

We report a case of recovered portal flow by ligation of the left renal vein on the first postoperative day after orthotopic liver transplantation of a 54-year-old female with alcoholic liver cirrhosis, chronic kidney failure, and spontaneous splenorenal shunt. After reperfusion, Doppler ultrasonography showed almost total diversion of the portal flow into the existing splenorenal shunt, but because of severe coagulopathy and diffuse bleeding, ligation of the shunt was not attempted. A programmed relaparotomy was performed on the first postoperative day, and the left renal vein was ligated just to the left of the inferior vena cava. Portal flows subsequently increased to 37&#x2009;cm/sec, and the patient presented a good and stable liver function. We conclude that patients with known preoperative splenorenal shunts should be closely monitored, and if the portal flow becomes insufficient, ligation of the left renal vein should be attempted in order to optimize the portal perfusion of the liver.

Lampros Kousoulas

Kristina Imeen Ringe

Michael Winkler

Frank Lehner

Nicolas Richter

Juergen Klempnauer

Fabian Helfritz

Ligation of Left Renal Vein for Spontaneous Splenorenal Shunt to Prevent Portal Hypoperfusion after Orthotopic Liver Transplantation

Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. This paper illustrates the potential deleterious consequences of high-output AVF after kidney transplantation and raises considerations regarding the impact of the fistula on cardiac status and kidney function after kidney transplantation and, consequently, the management AVF after transplantation.

Dominique Bertrand

Geoffroy Desbuissons

Nicolas Pallet

Albane Sartorius

Christophe Legendre

Marie-France Mamzer

Rebecca Sberro Soussan

Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic disease of the liver that is marked by inflammation of the bile ducts and damage to the hepatic biliary tree. Approximately 60&#x2013;70&#x25; of patients also have inflammatory bowel disease and progression of PSC can lead to ulcerative colitis and cirrhosis of the liver. Due to limited understanding of the etiology and mechanism of PSC, the only existing treatment option is orthotopic liver transplantation (OLT); however, recurrence of PSC, after OLT is estimated to be between 5&#x25; and 35&#x25;. We discuss the successful treatment of a pediatric patient, with recurrent PSC, after OLT with oral Vancomycin.

Yinka K. Davies

Cynthia J. Tsay

Dario V. Caccamo

Kathleen M. Cox


							Ricardo O. Castillo

Kenneth L. Cox

Successful Treatment of Recurrent Primary Sclerosing Cholangitis after Orthotopic Liver Transplantation with Oral Vancomycin

Vascular anomalies among living kidney donors are seldom encountered and their presence offers a complex opportunity for every transplant surgeon. Furthermore, there has been an increasing trend with the use of marginal or kidneys with pathology to address the shortage of organs. We report a rare case of a kidney allograft with a saccular aneurysm and renal cortical cysts for which an excision with primary repair and partial nephrectomy were done, respectively. The recipient was a 45-year-old female with lupus nephritis and significant comorbidities who had excellent recovery and outcome. With good surgical techniques, these types of grafts continue to provide acceptable outcome but safety of the donor should be of utmost importance.

Siegfredo Paloyo

Junichiro Sageshima

Linda Chen

George W. Burke

Gaetano Ciancio

Aneurysmectomy with Partial Nephrectomy on a Living Donor Renal Allograft: A Case Report

Introduction. Horseshoe kidney is a congenital anomaly that presents unique challenges for the transplant surgeon. The mere presence of horseshoe kidney should not preclude consideration for transplantation. Case Report. A 33-year-old women suffering from end-stage renal disease underwent deceased donor renal transplant with a divided horseshoe kidney. We present a postoperative complication and the technical strategy for transplant salvage. The patient currently has excellent graft function. Discussion. Horseshoe kidneys do present challenges for successful transplantation. Though case reports of successful transplantation are increasing, we present a technical complication and successful transplant salvage strategy. Technical descriptions in the literature of successful back-table preparation strategies should help more transplant surgeons to begin to utilize this resource. Conclusion. This study concludes that horseshoe kidneys can be successfully used for transplantation and provides a technical strategy to salvage the transplant after a unique complication associated with these donor kidneys.

J. T. Foster

P. E. Morrissey

Segmental Renal Ischemia following Transplantation of Horseshoe Kidney as Separate Allografts

Tuberous sclerosis is rarely associated with autosomal dominant polycystic kidney disease in the so-called tuberous sclerosis complex. This association leads to an increased frequency of end-stage renal disease. We present a patient suffering from both syndromes, who received a renal graft and anticalcineurinic drugs as immunosuppressive agents. Progressive titration of the drug was necessary in order to attain the effective doses due to the enzymatic induction caused by concomitant treatment with antiepileptic drugs. These high doses resulted in nephrotoxicity. Immunosuppressor treatment was switched to rapamycin, whereby an improvement in renal function and other signs of tuberous sclerosis and polycystic kidney disease was observed. This case report highlights both the efficacy and safety of rapamycin as an immunosuppressor treatment and its capacity for controlling other symptoms of these genetic-related disorders.

C. Rosado

P. Garc&#xed;a-Cosmes

P. Fraile

F. V&#xe1;zquez-S&#xe1;nchez

Tuberous Sclerosis Associated with Polycystic Kidney Disease: Effects of Rapamycin after Renal Transplantation

Acute kidney injury (AKI) is a recognised complication of intravenous pentamidine therapy. A direct nephrotoxic effect leading to acute tubular necrosis has been postulated. We report a case of severe renal allograft dysfunction due to nebulised pentamidine. The patient presented with repeated episodes of AKI without obvious cause and acute tubular necrosis only on renal histology. Nebulised pentamidine was used monthly as prophylaxis for Pneumocystis jirovecii pneumonia, and administration preceded the creatinine rise on each occasion. Graft function stabilised following discontinuation of the drug. This is the first report of nebulized pentamidine-induced reversible nephrotoxicity in a kidney allograft. This diagnosis should be considered in a case of unexplained acute renal allograft dysfunction.

Siddhesh Prabhavalkar

Agnes Masengu

Declan O'Rourke

Joanne Shields

Aisling Courtney

Nebulized Pentamidine-Induced Acute  Renal Allograft Dysfunction

About this journal

Case Reports in Transplantation publishes case reports and case series focusing on novel techniques as well as associated side effects and complications of heart, lung, kidney, liver, pancreas and stem cell transplantation.

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Case Reports in Transplantation maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

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Case Reports in Transplantation - Table of contents 2013

Case Reports in Transplantation | Hindawi

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Case Reports in Transplantation publishes case reports and case series focusing on novel techniques as well as associated side effects and complications of heart, lung, kidney, liver, pancreas and stem cell transplantation.

Case Reports in Transplantation