RESUMEN
The development of an arteriovenous fistula (AVF) after renal graft biopsy is a rare complication, it is associated in most cases with spontaneous resolution. However, interventional therapies are required in some cases, to prevent graft loss. Selective embolization has been described as an alternative treatment. In the present study, we describes our experience on AVF after biopsy in kidney transplant patients, which was managed with selective embolization. From 2005 to 2015, a total of 452 kidney transplant biopsies were performed, 12 had an AVF requiring embolization. In 92% of cases, this was successful. Beforehand, mean serum creatinine levels were 2.45 mg/dL, after the procedure, that increased to 3.05, however, 3 months later, mean creatinine levels dropped to 1.85 mg/dL. Graft survival after 2 follow-up years was 72%. Our experience demonstrates that selective embolization of the AVF after kidney transplant biopsy is a safe procedure, and that transplant function can be maintained in patients with this complication.
RESUMEN
La mucormicosis rino-órbito-cerebral es una infección micótica potencialmente mortal en los pacientes inmunosuprimidos. Los principales factores de riesgo para adquirirla son la diabetes mellitus mal controlada, la sobrecarga de hierro, la inmunosupresión potente y el uso crónico de esteroides. En esta revisión presentamos el caso de un paciente trasplantado de riñón que, luego del tratamiento de un rechazo agudo con dosis altas de esteroides e inmunosupresión potente con tacrolimus más micofenolato, presentó mucormicosis rino-órbito-cerebral de rápida progresión con necesidad de tratamiento quirúrgico agresivo, suspensión de la inmunosupresión y tratamiento antifúngico potente (AU)
Rhino-orbital-cerebral mucormycosis is a potentially fatal mycotic infection in immunosuppressed patients. The main risk factors for acquiring this infection are poorly controlled diabetes mellitus, iron overload, potent immunosuppression and chronic steroid use. In this review, we present the case of a kidney transplant patient who, after treatment of an acute rejection episode with high doses of steroids and potent immunosuppression with tacrolimus and mycophenolate, presented with rapidly progressing rhino-orbital-cerebral mucormycosis that required aggressive surgical treatment, immunosuppression discontinuation and potent antifungal treatment (AU)
Asunto(s)
Humanos , Masculino , Adulto , Mucormicosis/tratamiento farmacológico , Trasplante de Riñón , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Huésped Inmunocomprometido , Rechazo de Injerto/etiologíaRESUMEN
Rhino-orbital-cerebral mucormycosis is a potentially fatal mycotic infection in immunosuppressed patients. The main risk factors for acquiring this infection are poorly controlled diabetes mellitus, iron overload, potent immunosuppression and chronic steroid use. In this review, we present the case of a kidney transplant patient who, after treatment of an acute rejection episode with high doses of steroids and potent immunosuppression with tacrolimus and mycophenolate, presented with rapidly progressing rhino-orbital-cerebral mucormycosis that required aggressive surgical treatment, immunosuppression discontinuation and potent antifungal treatment.