title: Intra-arterial nitroglycerin for intra-operative arterial vasospasm during pediatric renal transplantation.
abstract: Intra-operative arterial vasospasm during pediatric renal transplantation is an urgent clinical situation resulting in end-organ ischemia, associated changes in parenchymal turgor and color, diminished flow on ultrasound, and if left untreated, allograft loss. We hypothesized that intra-operative intra-arterial injection of nitroglycerin would reverse vasospasm and improve renal perfusion. A three-yr-old girl with end-stage renal disease due to autosomal recessive polycystic kidney disease on peritoneal dialysis underwent deceased donor renal transplantation. After optimal immediate reperfusion and hemodynamic parameters, the kidney lost turgor and became mottled in appearance despite adequate hilar arterial and venous Doppler waveforms. Two aliquots of 40 μg (0.4 mL of a 100 μg/mL) nitroglycerin solution were injected directly into the renal artery 10 min apart. Nitroglycerin resulted in dramatic change in the consistency and appearance of the allograft. An improvement in renal blood flow was demonstrated by ultrasound after the second intra-arterial nitroglycerin injection with only a transient decrease in systemic arterial blood pressure. The child experienced normal allograft perfusion on serial postoperative ultrasounds, with a prompt decrease in serum creatinine and excellent diuresis. Intra-arterial nitroglycerin is a promising option for intra-operative arterial vasospasm during pediatric renal transplantation with objective improvement in blood flow and perfusion.
authors.affiliation: Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Penna
authors.affiliation: Division of Nephrology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harvey
authors.affiliation: Division of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: John
authors.affiliation: Division of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: Division of Anesthesia, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Igor
authors.initials: I
authors.lastname: Luginbuehl
authors.affiliation: Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Rakan I
authors.initials: RI
authors.lastname: Odeh
authors.affiliation: Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Fahad
authors.initials: F
authors.lastname: Alyami
authors.affiliation: Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Koyle
authors.affiliation: Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
mesh_terms: D064591:Allografts; D002675:Child, Preschool; D003329:Coronary Vasospasm / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007269:Injections, Intra-Arterial; D007432:Intraoperative Period; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D005996:Nitroglycerin / Q000008:administration & dosage*; D010477:Perfusion; D017044:Polycystic Kidney, Autosomal Recessive / Q000601:surgery*; D012077:Renal Artery; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: intra-arterial injections; kidney transplantation; nitroglycerin; pediatrics