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PRESENTATION #13 Case Report | Pediatric Anesthesia

CONSECUTIVE CARDIAC AND RENAL TRANSPLANTATIONS IN A PEDIATRIC PATIENT, A FIRST FOR OCHSNER MEDICAL CENTER

Jimmie Colón, MD, Ochsner Medical Center

Presenter: Jacob Boudreaux, BS
UQ – Ochsner

Consecutive cardiac and renal transplantations are an effective surgical strategy for pediatric patients with combined cardiac and renal failure. The complex pathophysiologic relationship between both organs is multifactorial in origin and may lead to or be the result of a primary dysfunction of either organ system. Cardiorenal syndrome (CRS) refers to a complex pathophysiologic state in which the heart and kidney dysfunction coexist, and the primary failing organ can be either the heart or the kidney. For patients with a history of organ transplantation, CRS may be due to low cardiac output, nephrotoxicity of immunosuppressants, or ischemic renal hypoperfusion.

Limited reports have been made regarding consecutive cardiac and renal transplantations. We report the medical history, anesthetic management, and postoperative outcome for a 13-year-old boy with a past medical history of orthotopic cardiac transplantation with multiple episodes of rejection and acute kidney injury requiring dialysis who received consecutive cardiac and renal transplantations, a first at Ochsner Medical Center in New Orleans, Louisiana.

Consecutive cardiac and renal transplantations in a pediatric patient have yet to be undertaken at Ochsner Medical Center. The patient’s extensive medical history and increased risk of postoperative morbidity and mortality warrant attentive, multidisciplinary postoperative management. The multidisciplinary approach for children with CRS should include a pediatric nephrologist in conjunction with a pediatric cardiologist to increase the accuracy of detecting early signs and symptoms of CRS in the pediatric population.