Bahena-Carrera L, Jiménez-Peña B, Ramos-Díaz EE, Martínez-Lázaro O, López-Sánchez RE, Osorio-Rodríguez GA, Noyola-Villalobos HF

Language: Spanish
References: 13
Page: 68-73
PDF size: 301.86 Kb.

ABSTRACT

Introduction: There are HLA or ABO immunological barriers, glomerulopathies recurrence or hereditary diseases that contraindicate direct related donation to pediatric renal recipient. Rapaport proposed in 1986 the possibility exchange donors so that each recipient receives a compatible kidney and the donors realize their wish to donate. In Mexico, there have been kidney transplants in adults with donor exchanges since 2016, and the central military hospital formally began this program in 2018, including pediatric recipients. Atypical hemolytic uremic syndrome (aHUS) is an etiology of chronic kidney disease that contraindicates related kidney donation. Clinical case: A 13-year-old pediatric male with chronic kidney disease G5 KDIGO diagnosis by aHUS secondary to a DGKE mutation in 2019. Due to the same mutation in both parents, it was proposed to enter a donor exchange program. The case was accepted by the transplant committee at 2020 end, finding a compatible donor under the kidney exchange program using Alvin Roth's mathematical algorithm. The preoperative studies were: hemoglobin 9 g/dL, leukocytes 5,970 × 10³/μL, creatinine 7.7 mg/dL, urea 100.6 mg/dL. Warm ischemia time of 22 minutes, cold ischemia time 17 minutes. Eculizumab 600 mg IV was applied on day -1 and +14; the immunosuppression induction was carried out with CD-25, tacrolimus, mycophenolic acid and steroid, the patient was discharged on the seventh day with creatinine 0.7 mg/dL, Hb 9.4 g/dL, leukocytes 10,180 × 10³/μL, tacrolimus levels 1.7 ng/mL. The glomerular filtration rate three and a half months post-transplant is 116 ml/min/1.73 m² and his follow-up without surgical, medical or infectious complications.

REFERENCES

1. Akkina SK, Muster H, Steffens E, Kim SJ, Kasiske BL, Israni AK. Donor exchange programs in kidney transplantation: rationale and operational details from the north central donor exchange cooperative. Am J Kidney Dis. 2011; 57 (1): 152-158.

2. McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004; 350: 2654-2662.

3. Axelrod DA, Schnitzler MA, Xiao H, Irish W, Tuttle-Newhall E, Chang SH et al. An economic assessment of contemporary kidney transplant practice. Am J Transplant. 2018; 18: 1168-1176.

4. Newsletter Transplant. EDQM, 2020; 25: 57.

5. Nayak AB, Ettenger RB, McGuire S, Lipshutz GS, Reed EF, Veale J, Tsai EW. Optimizing HLA matching in a highly sensitized pediatric patient using ABO-incompatible and paired exchange kidney transplantation. Pediatr Nephrol. 2015; 30: 855-858.

6. Hebert SA, Swinford RD, Hall DR, Au JK, Bynon JS. Special considerations in pediatric kidney transplantation. Adv Chronic Kidney Dis. 2017; 24 (6): 398-404.

7. Chandar J, Chen L, Defreitas M, Ciancio G, Burke G. Donor considerations in pediatric kidney transplantation. Pediatr Nephrol. 2021; 36 (2): 245-257.

8. Zuber J, Fakhouri F, Roumenina LT, Loirat C and Frémeaux-Bacchi V. Use of eculizumab for atypical haemolytic uraemic syndrome and C3 glomerulopathies. Nat Rev Nephrol. 2012; 8 (11): 643-657.

9. Massie AB, Gentry SE, Montgomery RA, Bingaman AA, Segev DL. Center-level utilization of kidney paired donation. Am J Transplant. 2013; 13 (5): 1317-1322.

10. Kute VB, Gumber MR, Vanikar AV, Shah PR, Patel HV, Engineer DP et al. Comparison of kidney paired donation transplantations with living related donor kidney transplantation: implications for national kidney paired donation program. Ren Fail. 2013; 35 (4): 504-508.

11. Sypek MP, Alexander SI, Cantwell L, Ierino FL, Ferrari P, Walker AM et al. Optimizing outcomes in pediatric renal transplantation through the Australian paired kidney exchange program. Am J Transplant. 2017; (2): 534-541.

12. Verghese PS. Pediatric kidney transplantation: a historical review. Pediatr Research. 2017; 81 (1-2): 259-264.

13. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 Edition). Transplantation. 2019; 103 (2): 218-219.