Endotoxin and Cytokines Removal with Adsorption Device in a Child with Sepsis After Transplantectomy (Case Report)

Abstract

Sepsis is one of the leading causes of death in kidney transplant recipients.We present our experience of effective removal of bacterial endotoxins and endogenous inflammatory mediators using a multimodal hemosorbent in sepsis, caused by gram-negative polyresistant Klebsiella spp. including K. pneumoniae. The device was used in a 15 y.o. patient after treatment failure of graft-bed abscess and removal of kidney transplant.Results. Two 24-hour sorption procedures on Days 3 and 5 post-transplantectomy in combination with renal replacement therapy resulted in consistent decrease of pro-inflammatory markers concentrations (procalcitonin — 15.111.47.2 ng/ml; C-reactive protein — 23419990 mg/l), preventing therefore further progression of multiple organ dysfunctions.Conclusion. Inclusion of selective adsorption of cytokines and/or lipopolysaccharides into multimodal intensive therapy in an immunosuppressed pediatric patient with sepsis caused by resistant microorganisms improved treatment outcomes.