Preventing acute rejection with basiliximab and triple immunosuppression after renal transplantation

Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients

We report two cases of non-cardiogenic pulmonary edema as a complication of basiliximab induction therapy in young pediatric renal transplant patients identified following a retrospective review of all pediatric renal transplant cases performed in the National Paediatric Transplant Centre, Childrens University Hospital, Temple Street, Dublin, Ireland. Twenty-eight renal transplantations, of which five were living-related (LRD) and 23 were from deceased donors (DD), were performed in 28 children between 2003 and 2006. In six cases, transplantations were pre-emptive. Immunosuppression was induced pre-operatively using a combination of basiliximab, tacrolimus and methylprednisolone in all patients. Basiliximab induction was initiated 2 h prior to surgery in all cases and, in 26 patients, basiliximab was re-administered on post-operative day 4. Two patients, one LRD and one DD, aged 6 and 11 years, respectively, developed acute non-cardiogenic pulmonary edema within 36 h of surgery. Renal dysplasia was identified as the primary etiological factor for renal failure in both cases. Both children required assisted ventilation for between 4 and 6 days. While both grafts had primary function, the DD transplant patient subsequently developed acute tubular necrosis and was eventually lost within 3 weeks due to thrombotic microangiopathy and severe acute antibody-mediated rejection despite adequate immunosuppression. Non-cardiogenic pulmonary edema is a potentially devastating post-operative complication of basiliximab induction therapy in young pediatric patients following renal transplantation. Early recognition and appropriate supportive therapy is vital for patient and, where possible, graft survival.

Renal transplantation in Slovenia after joining Eurotransplant

BACKGROUND

This report presents data on renal transplantation in Slovenia before and after joining Eurotransplant (ET).

METHODS

Slovenia (population: 2 million) has one renal transplant centre. The establishment of an appropriate national transplantation organization resulted in an increase in transplantations and the acceptance of Slovenia into ET at the beginning of 2000. Current immunosuppression is composed of cyclosporin (Neoral), mycophenolate mofetil, methylprednisolone and anti-interleukin-2 receptor monoclonal antibodies.

RESULTS

By the end of 2004, 607 renal transplantations had been performed. From 1970 to 1998, 124 patients were given living related donor kidneys. From 1986 to 1999, 239 patients received renal grafts from deceased donors. From 2000 to 2004, 244 patients were transplanted from deceased donors. In 2004, 55 renal transplantations were carried out. One hundred and forty one (57.8%) renal grafts were shipped from other ET countries. The HLA-antigen mismatch of 2.8+/-1.1 was not significantly different from what it was before 2000. Up to 31 December 2004, the 1- and 3-year patient survival rates were 98.3% and 96.0%, respectively. The concomitant graft survival rates were 95.8% and 93.5%, respectively.

CONCLUSIONS

In the ET era, the number of deceased donor renal transplants per year was 2.8 times higher than in the 14 years before. In 2004, we reached the average number of deceased donor renal transplants per million population of ET. Although tissue compatibility in these recipients was not significantly better than it was before the ET era, it would have been much worse had we not joined ET. Short- and medium-term results in the ET era have been entirely comparable to those in large reports.