Graft Intolerance Syndrome in Children Treated with Kidney Embolization: A Case Report

During post-transplant evolution, adolescents may present problems with adherence to treatment, becoming a high-risk group for graft loss. Here, we report a case which describes an adolescent patient who lost a graft due to humoral rejection associated with lack of adherence to treatment. During chronic peritoneal dialysis therapy, the patient developed pain and increased volume in the graft area, fever, gross hematuria and leukocyturia upon urine examination. The patient was diagnosed with graft immune intolerance syndrome and transplantectomy was suggested. Finally, a graft embolization was performed. A decrease in symptoms was observed until the patient became asymptomatic.

Moyamoya Syndrome in Post-Transplant Children with Type 1 Neurofibromatosis and Congenital Nephrotic Syndrome

Background: Neurofibromatosis (NF) is a genetic disorder of the nervous system that affects the development and growth of neuronal tissues. It is characterized by the development of malignant and benign tumors of the peripheral nerves and meningiomas, and the clinical manifestations can vary, including cerebral vascular compromise that precipitates symptoms characteristic of Moyamoya syndrome. The behavior of a posttransplant child with type 1 NF who presents with characteristics of Moyamoya syndrome and is a carrier of a WT1 genetic mutation is unknown, which is why the report was made. Case Report: A child with type I NF with a history of cryptorchidism, hypospadias, bilateral sensorineural hearing loss, and chronic renal failure was arising from a congenital nephrotic syndrome due to a WT1 gene mutation at 3 years of age began renal replacement therapy initially with chronic ambulatory peritoneal dialysis and hemodialysis for refractory peritonitis. He underwent two episodes of transient ischemic attack (TIA) characterized by right hemiparesis during hemodialysis therapy and during six months post-kidney transplantation present a similar episode. Studies for other causes were negative, and imaging studies show characteristics of NF-related vasculitis, cortical lesions, and focal lesions in the left frontal subcortical white matter with annular enhancement and subcortical edema in the parasagittal region of the left parietal lobe, as well as a decrease in flow in the cortical branches of the middle cerebral artery were described. After four weeks, the clinical manifestations of hemiparesis completely disappeared without leaving any sequels continuing with the regular immunosuppression of the everolimus, mycophenolate and low dose steroids. Conclusion: These findings are suggestive of small and mediumsized vessel vasculitis compatible with Moyamoya syndrome in child post-transplantation associated with arteriopathy by NF.

Surgical Complications and Evolution of Grafts in Children with Renal Transplantation at Cayetano Heredia National Hospital

Objective: This study aims to determine surgical complications and graft outcome in children undergoing renal transplantation at Cayetano Heredia National Hospital (CHNH). Materials and Methods: A case study series focused on the incidence of surgical complications and graft outcome in pediatric patients with end stage renal disease (ESRD) who underwent renal transplant (RT) between December 2007 and March 2011. Results: The study described 29 pediatric transplant patients whose average age was 13.69 ± 3.38 (6.2-17.9) years. The etiology of end stage renal disease (ESRD) was renal hypoplasia in 12 patients (41.38%), primary glomerulopathy in 10 patients (34.48%), obstructive uropathy in 4 patients (13.79%), vasculitis in 2 patients (6.9%) and hemolytic uremic syndrome (HUS) in 1 (3.45%) patient. There were 11 surgical complications (34.48%): 2 cases of arterial thrombosis, 3 cases of urinary fistula, 3 of lymphocele, 1 of venous thrombosis, urinoma and perineal collection. The follow-up time was 15.84 ± 12.19 months. Graft survival at 12, 24, and 40 months was 89.29%, 77.16% and 77.16%, respectively. Conclusion: Surgical complications and graft survival in pediatric renal transplantation in our series did not differ from other published series.