Résumé
Antibody-mediated rejection [ABMR] jeopardises short- and long-term transplant survival and remains a challenge in the field of organ transplantation. We report the first use of the anticomplement agent eculizumab in Oman in the treatment of a 61-year-old female patient with ABMR following a living unrelated kidney transplant. The patient was admitted to the Sultan Qaboos University Hospital in Muscat, Oman, in 2013 on the eighth day post-transplantation with serum creatinine [Cr] levels of 400 [micro]mol/L which continued to rise, necessitating haemodialysis. A biopsy indicated ABMR with acute cellular rejection. No improvement was observed following standard ABMR treatment and she continued to require dialysis. Five doses of eculizumab were administered over six weeks with a subsequent dramatic improvement in renal function. The patient became dialysis-free with serum Cr levels of 119 [micro]mol/L within four months. This case report indicates that eculizumab is a promising agent in the treatment of ABMR
Résumé
Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters [TVCs] at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman
Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications [such as catheter-related infections or thrombosis] were collected
Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female [42.2%] and 93 were male [57.8%]. The mean age of the patients was 54.4 +/- 17.3 years. The most common reason for catheter placement was the initiation of dialysis [63.4%]. A total of 203 procedures were technically successful [99.5%]. The right internal jugular vein was the most common site of catheter placement [74.9%]. Mild haemorrhage which resolved spontaneously occurred in 11 cases [5.4%]. No other complications were observed. Subsequent follow-up data was available for 132 catheters [65.0%]; of these, thrombosis-related catheter malfunction was observed in 22 cases [16.7%] and catheter-related infection in 29 cases [22.0%]. Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature