Cochlear implantation after renal transplantation

Cochlear implantation after solid organ transplantation: long term results and review of the literature

OBJECTIVE

To analyze rate and type of complications in cochlear implant (CI) recipients receiving immunosuppressive therapy following solid organ transplant (SOT).

STUDY DESIGN

Retrospective case series. English language literature review.

SETTING

Tertiary referral center.

INTERVENTION

Cochlear implantation surgery following solid organ transplantation (SOT) and immunosuppressive therapy.

METHODS

Data of patients who received CI after SOT and with at least one year of follow up were reviewed. Main outcome measures were the rate and type of complications, classified as major (requiring a second surgical procedure) and minor (requiring medical therapy). A search was performed in PubMed database on January 2019 using the keywords: organ transplant; cochlear implant, complications, deafness, solid organ transplant, immunosuppressive therapy. Only studies reporting on patients who have been implanted after the transplant procedure and with a follow up period of at least 1 year were considered. Final analysis was performed on pooled data.

RESULTS

Four patients received CI surgery following SOT. Age at treatment ranged from 40 to 47 years (mean 44.25 years). Follow-up after implantation averaged 5.25 years (range 1-10 years), without complications. Review of the available literature on the subject yielded seven papers; a total of 26 procedures in 22 patients satisfied inclusion criteria. Pooled data from the present series and from the literature were analyzed; the global rate of complications was 16.6%, with 10% major (3 of 30 procedures) and 6.6% minor (2 of 30 procedures). The three reported cases of major complications appear unrelated to SOT. Major complications were found in one case over 16 procedures in pediatric patients (6.2%), while in adults the percentage raised to 14.3% (2/14 procedures).

CONCLUSIONS

Cochlear implantation is a safe and effective intervention, even during immunosuppressive therapy after organ transplantation.

Cochlear Implantation in Organ Transplant Recipients

OBJECTIVE

Immunosuppressed individuals who have undergone organ transplants, especially children, pose particular challenges in terms of treatment. The aim of this study was to analyze the postoperative complication rate of organ transplant recipients who have also received a cochlear implant (CI).

STUDY DESIGN

Retrospective case series.

SETTING

Tertiary referral center.

INTERVENTION

The case series includes 13 kidney, liver, lung, and heart transplant patients. Age at treatment ranged from 2 to 71 years, with a total of 17 CIs.

MAIN OUTCOME MEASURES

Postoperative complications were classified into major and minor, early (within 3 mo postoperatively) and late (>3 mo postoperatively). The results were compared with those for 13 1:1 matched pairs obtained and from our database and a healthy patient collective from our department.

RESULTS

The global postoperative complication rate was 29.4%. The proportion of patients suffering major complications was 17.6%, with 17.6% having minor complications. Complications that occurred early accounted for 13.3%, and late for 26.7%. No adults, and 33.0% of children, showed any complications after cochlear implantation. The global complication rate (29.4%) was significantly increased compared with the matched pairs (0%, p = 0.013) and department data (13.8%, p = 0.006; Cramers v = 0.102).

CONCLUSION

This study demonstrates that organ transplant recipients, and especially children, are at increased risk of postoperative complications after cochlear implantation in comparison with healthy CI recipients.

[Changes of the auditory function in he children with chronic kidney failure]

The risk factors that contribute to the development of hearing loss in the children with chronic kidney failure (CRF) are complications and/or manifestations of the disease itself as well as the side effects of its treatment. There are many similarities between the anatomical, physiological, and pharmacological features of the nephron and the striavascularis of the cochlea. The objective of the present study was the evaluation of the status of the auditory function in the children presenting with CRF.

MATERIAL AND METHODS

A total of 62 children with CRF were examined. 40 patients were on peritoneal dialysis and 9 on hemodialysis whereas 13 children did not receive hemodialysis. Kidney was transplanted in 7 patients. The registration of transient evoked otoacoustic emission (TEOAE) was performed in all the children. For patients without TEOAE complex underwent the audiological examination.

RESULTS

The TEOAE was not registered in 17 of the 62 examined children. According to the results of the comprehensive audiological examinations, 13 children suffered from the hearing loss of different forms and severity while 5 children presented with bilateral deafness. As the duration of CRF progressed, the patients became more prone to develop hearing impairment. Hearing loss is possibly genetically determined. Among the etiological factors underlying the development of the hearing loss the high doses of immunosuppressants and aminoglycosides are considered to be the principal ones.

Cochlear implantation of solid organ transplant patients receiving immunosuppressive therapy

OBJECTIVE

To evaluate the incidence of infectious complications and healing problems in cochlear implant (CI) patients receiving immunosuppressive therapy following solid organ transplant.

STUDY DESIGN

IRB-approved retrospective chart review of implanted patients.

SETTING

Tertiary care children's hospital.

METHODS

Seven patients of the more than 1000 implanted during the time period between 1991 and 2014 underwent cochlear implantation while on immunosuppressive therapy after having received a solid organ transplant. Their charts were reviewed for demographic and medical information pre- and post-implantation. The 4 males and 3 females ranged in age at CI from 2.4 to 18.8 years, with a mean of 9.0 years. Postimplant follow-up averaged 3.9 years (range: 0.1-13.1). Main outcome measures were occurrence of wound healing, infectious complications, whether open-set word recognition was achieved, and communication mode(s).

RESULTS

No wound infections or delayed healing, mastoiditis, or bacterial meningitis occurred after cochlear implantation. All seven patients had received at least one pneumococcal vaccination prior to implantation. Five of 6 (83%) developed open-set speech perception, of whom 4 (67%) use only oral communication.

CONCLUSION

In our series of patients receiving immunosuppressive therapy following solid organ transplantation, none developed wound healing or infectious complications after cochlear implantation. History of solid organ transplantation alone should not be a contraindication to cochlear implant candidacy which would deprive the child of the potential benefits of hearing, including language development.

Cochlear implantation in a patient with combined renal and liver transplantation

OBJECTIVE AND IMPORTANCE

Patients who have undergone solid organ transplantation and continuing immunosuppressant medication are at a higher risk of wound problems and infections following cochlear implantation. This risk is theoretically even further increased in multi-organ transplant recipients due to the increased doses of immunosuppressive medications that these patients are administered.

CLINICAL PRESENTATION AND INTERVENTION

Here, we present the first reported case of successful cochlear implantation in a patient who had previously undergone successful combined liver and kidney transplant. She had no significant complications from the surgery and had good audiological outcomes 3 months post-operatively.

CONCLUSION

As we continue our advances in the use of cochlear implant technology, our report adds to the growing evidence of its benefits in transplant recipients. However, there are important pre- and peri-operative considerations in this group of patients which can improve safety and outcome.