Steal syndrome after kidney transplantation caused by A-V fistula at the thigh.
The cases of two low-weight children are reported, who became dialysis patients at the age of 2.5 and 5.5 years, respectively, and were hemodialyzed by way of a bovine artgraft A-V fistula at the thigh. One year later, both patients were successfully transplanted with a cadaveric kidney. Immunosuppression was carried out in the first 3 weeks with prednisone, azathioprine and ciclosporin, later on with prednisone and ciclosporin. The first patient (A-V fistula at the right thigh) was transplanted on the right fossa iliaca. After an acute rejection episode 11 days after kidney transplantation, successfully treated by prednisolone pulse therapy, there was another episode similar to rejection after 5 weeks. This episode was complicated by a hypertensive crisis with convulsion. Again bolus injections of prednisolone were performed, but kidney function declined rapidly. Diagnostics (perfusion scintigraphy with Tc-DTPA, digital substraction angiography) demonstrated hypoperfusion of the graft, caused by a steal syndrome due to the A-V fistula in the groin. Ligation of the fistula resulted in rapid improvement of renal function and decrease in blood pressure occurred. The second patient was transplanted on the fossa iliaca contralaterally of the A-V fistula in the groin. Twenty-one days after kidney transplantation we saw a rejection episode accompanied by cytomegalovirus (CMV) infection. After bolus injection of prednisolone and CMV-antibody treatment in the beginning, stabilization of kidney function was seen. But the following week we experienced an unexplainable deterioration of graft function followed by progressive acute renal failure. Again, a steal syndrome due to the contralateral A-V fistula could be demonstrated. After ligation of the A-V fistula renal function normalized within 14 days. Currently graft function is satisfactory in both patients.
Kuwertz-Bröking
E
E
Childrens Hospital, Pediatric Nephrology, Westfalische Wilhelms, Universität Münster, FRG.
Bulla
M
M
Langer
K
K
Frosch
M
M
Lison
A E
AE
Buchholz
B
B
Peters
P
P
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D012079:Renal Circulation; D013577:Syndrome; D013848:Thigh