Successful treatment of nonocclusive mesenteric ischemia that developed during the peritransplant period following ABO-incompatible kidney transplantation.
Nonocclusive mesenteric ischemia (NOMI) is an infrequent and fatal disorder. We describe a 54-year-old man who developed NOMI during the peritransplant period following ABO-incompatible living-donor kidney transplantation, but who was successfully treated with his renal graft function unimpaired. Abdominal pain appeared on the sixth postoperative day (POD), and emergency surgery was performed on POD 8. Discontinuous segmental necrosis extended throughout the small intestine, and the necrotic segments were entirely removed. He thereafter had ischemia of the ascending colon, which was treated with colectomy, and prostaglandin E1 delivered through the related artery prevented advanced necrosis. Temporary colostomy was closed 20 months after surgery. He maintains excellent graft function at present without secondary disorder. There has been no ABO-incompatible kidney transplant recipient complicated with NOMI. However, patients with end-stage renal disease are at the highest risk for this lethal condition, and physicians and urologists should correctly recognize its diagnostics and therapeutics.
Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8510, Japan. masa1214@med.niigata-u.ac.jp
Masayuki
M
Tasaki
Kazuhide
K
Saito
Yuki
Y
Nakagawa
Noboru
N
Hara
Akifumi
A
Kuwabara
Shintaro
S
Komukai
Manabu
M
Ohashi
Haruhiko
H
Okamoto
Toshiki
T
Tanikawa
Tsutomu
T
Nishiyama
Kota
K
Takahashi
D000017:ABO Blood-Group System / Q000276:immunology; D000527:Alprostadil / Q000627:therapeutic use; D001787:Blood Group Incompatibility / Q000150:complications; D003125:Colostomy; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D009336:Necrosis / Q000150:complications; D012086:Reoperation; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000527:Alprostadil