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.
Dolan
Niamh
N
Department of Nephrology, Children's University Hospital, Dublin, Ireland. dolanniamh@eircom.net
Waldron
Mary
M
O'Connell
Marie
M
Eustace
Nick
N
Carson
Kevin
K
Awan
Atif
A
D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000077552:Basiliximab; D002648:Child; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000276:immunology*; D007686:Kidney Tubules, Distal / Q000473:pathology; D019520:Living Donors; D008297:Male; D009336:Necrosis / Q000473:pathology; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D012189:Retrospective Studies; D014019:Tissue Donors; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab