Successful deceased donor renal transplant in a sensitized pediatric recipient with the use of plasmapheresis

Abstract:  Sensitization following renal transplant is a significant barrier to repeat transplantation in children. We report a successful DD renal transplant, with the use of PP, in an 11-yr-old girl who became highly sensitized following a prior failed transplant. She received PP treatments after failure of high-dose IVIg (Gamimune^®). We established the effectiveness of PP by attaining a 0% PRA and negative cross-matches after five PP treatments. Subsequently, our patient underwent a second round of scheduled PP. When the PRA was 0%, unacceptable antigens were removed from the UNOS wait list, PP was continued, and a kidney became available within 10 days. The final flow cytometry cross-match with the eventual donor was negative. This success demonstrates that coordination of desensitization by PP and advanced laboratory monitoring techniques with recent policies regarding allocation of organs to pediatric patients provides new opportunities for children awaiting transplantation. Since the transplant, our patient sustained a low-titer increase of anti-HLA antibodies. However, she has had no episodes of acute rejection and has maintained excellent graft function more than 17 months later.     

Preoperative characteristics and a potential mechanism of chronic dry eye after LASIK

PURPOSE: To determine whether measurable preoperative characteristics predispose patients to chronic dry eye after laser in situ keratomileusis (LASIK). METHODS: The study consisted of 24 eyes of 24 patients who underwent LASIK. Tear breakup time, Schirmer testing with and without anesthesia, rose bengal staining, central corneal sensitivity, nucleus-to-cytoplasmic ratio, and goblet cell density were evaluated 2 weeks before and 1 week, 3 months, and 9 months after surgery. Patients were classified into two outcome groups, the nondry-eye group (NDEG) and the chronic dry-eye group (CDEG), on the basis of dry eye status 9 months after surgery. The authors tested whether preoperative values of each parameter were associated with the development of chronic dry eye. RESULTS: All parameters, except rose bengal staining, deteriorated significantly after surgery but returned to preoperative levels within 3 to 9 months. The CDEG had significantly lower preoperative Schirmer test values with and without anesthesia and were delayed in recovery after surgery in goblet cell density, rose bengal staining, Schirmer test values without anesthesia, and tear breakup time. Results of preoperative Schirmer tests without anesthesia positively correlated with tear breakup time 9 months after surgery. CONCLUSIONS: Preoperative tear volume may affect recovery of the ocular surface after LASIK and may increase the risk for chronic dry eye.