title: Ethylene oxide allergy in patients on hemodialysis waiting for kidney transplantation: logistical nightmare or challenge? A case report.
abstract: Ethylene oxide (EO) is widely used as a sterilization gas for heat-sensitive devices. In EO-sensitized patients, this type of sterilization can cause rare but major allergic reactions such as hives, rash, asthma, or anaphylactic shock. Hemodialysis patients in particular are at risk of developing hypersensitivity to EO. In these patients, surgical interventions should be planned far in advance allowing a thorough EO-free preparation of all equipment needed for the surgery as well as for the pre-, peri-, and postoperative care. In contrast to elective surgery, kidney transplantation with allografts from deceased donors cannot be planned; exact timing is unpredictable. Furthermore, transplantation may take place years after patients have been put on the waiting list. Listing of patients sensitive for EO is therefore a logistical and medical challenge for all health care professionals involved in the patient's care (eg, surgeons, nephrologists, anesthetists, nurses, pharmacists, and sterilization specialists). This case report describes a patient with chronic kidney disease stage V who developed EO allergy during hemodialysis while waiting for a kidney transplantation. Diagnosis was made based on clinical signs and confirmed biochemically (including a positive radioallergosorbent test). Because the only treatment is avoidance of contact with EO-sterilized materials, a strict EO-free protocol was developed to allow an uneventful transplantation thereafter. Subsequently, 4 newly diagnosed EO-sensitive patients on the active kidney transplantation waiting list were diagnosed, and 1 of these patients has been transplanted successfully. EO allergy in patients on the waiting list for kidney transplantation is a unique challenging situation which, to the best of our knowledge, has not been reported yet for kidney transplantation. This report further highlights the logistical preparation of a renal transplantation, including anesthesiologic, surgical, and postoperative care.
authors.affiliation: Department of Abdominal Transplant Surgery on behalf of the Ethylene Oxide Free Task Force Council, University Hospitals Leuven, Leuven, Belgium. diethard.monbaliu@uzleuven.be
authors.forename: D
authors.initials: D
authors.lastname: Monbaliu
authors.forename: A
authors.initials: A
authors.lastname: Van Breussegem
authors.forename: A
authors.initials: A
authors.lastname: Onsia
authors.forename: E
authors.initials: E
authors.lastname: Vandermeersch
authors.forename: C
authors.initials: C
authors.lastname: Segers
authors.forename: W
authors.initials: W
authors.lastname: Meert
authors.forename: A-M
authors.initials: AM
authors.lastname: Kochuyt
authors.forename: J
authors.initials: J
authors.lastname: Pirenne
authors.forename: K
authors.initials: K
authors.lastname: Claes
mesh_terms: D000328:Adult; D004202:Disinfectants / Q000009:adverse effects*; D004342:Drug Hypersensitivity; D005027:Ethylene Oxide / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D006435:Renal Dialysis; D014850:Waiting Lists
chemical_list: D004202:Disinfectants; D005027:Ethylene Oxide