Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature

We report two cases of successful renal transplantation with allografts from donors who suffered anoxic brain injury as the primary cause of death from house fires. Each was treated prophylactically with hydroxocobalamin (Cyanokit) for suspected cyanide toxicity. During organ procurement, gross exam...

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Main Authors: Ryan J. Hendrix, Paulo N. Martins, Jeffrey S. Stoff, Aaron Ahearn, Adel Bozorgzadeh, Babak Movahedi
Format: Article
Language:English
Published: Wiley 2018-01-01
Series:Case Reports in Transplantation
Online Access:http://dx.doi.org/10.1155/2018/3753479
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author Ryan J. Hendrix
Paulo N. Martins
Jeffrey S. Stoff
Aaron Ahearn
Adel Bozorgzadeh
Babak Movahedi
author_facet Ryan J. Hendrix
Paulo N. Martins
Jeffrey S. Stoff
Aaron Ahearn
Adel Bozorgzadeh
Babak Movahedi
author_sort Ryan J. Hendrix
collection DOAJ
description We report two cases of successful renal transplantation with allografts from donors who suffered anoxic brain injury as the primary cause of death from house fires. Each was treated prophylactically with hydroxocobalamin (Cyanokit) for suspected cyanide toxicity. During organ procurement, gross examination was notable for deep discoloration of the parenchymal tissues. Approximately 6 and 18 months after transplantation, both recipients have excellent renal graft function and remain independent from hemodialysis (HD). Hydroxocobalamin is the antidote for suspected acute cyanide toxicity. While largely tolerated by the recipient, there is concern over the potential functional implications of the associated side effects of dramatic tissue discoloration and development of oxalate crystals. Furthermore, difficulties performing hemodialysis in patients treated with hydroxocobalamin have been reported due to discoloration of the effluent fluid impacting the colorimetric sensor, causing false alarms and repetitive interruptions. As such, many transplant centers in the United States (US) continue to reject these organs. We seek to highlight two cases of successful transplantation following donor administration of hydroxocobalamin (Cyanokit) and present the first documented case of successful perioperative intermittent hemodialysis following transplantation of an allograft exposed to hydroxocobalamin. Furthermore, we emphasize the importance of optimal organ utilization and caution against unnecessary refusal.
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spelling doaj-art-091db9202312488b94a171de395d9da52025-02-03T01:10:05ZengWileyCase Reports in Transplantation2090-69432090-69512018-01-01201810.1155/2018/37534793753479Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the LiteratureRyan J. Hendrix0Paulo N. Martins1Jeffrey S. Stoff2Aaron Ahearn3Adel Bozorgzadeh4Babak Movahedi5University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USAUniversity of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USAUniversity of Massachusetts Medical School, Department of Medicine, Division of Nephrology, USAUniversity of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USAUniversity of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USAUniversity of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USAWe report two cases of successful renal transplantation with allografts from donors who suffered anoxic brain injury as the primary cause of death from house fires. Each was treated prophylactically with hydroxocobalamin (Cyanokit) for suspected cyanide toxicity. During organ procurement, gross examination was notable for deep discoloration of the parenchymal tissues. Approximately 6 and 18 months after transplantation, both recipients have excellent renal graft function and remain independent from hemodialysis (HD). Hydroxocobalamin is the antidote for suspected acute cyanide toxicity. While largely tolerated by the recipient, there is concern over the potential functional implications of the associated side effects of dramatic tissue discoloration and development of oxalate crystals. Furthermore, difficulties performing hemodialysis in patients treated with hydroxocobalamin have been reported due to discoloration of the effluent fluid impacting the colorimetric sensor, causing false alarms and repetitive interruptions. As such, many transplant centers in the United States (US) continue to reject these organs. We seek to highlight two cases of successful transplantation following donor administration of hydroxocobalamin (Cyanokit) and present the first documented case of successful perioperative intermittent hemodialysis following transplantation of an allograft exposed to hydroxocobalamin. Furthermore, we emphasize the importance of optimal organ utilization and caution against unnecessary refusal.http://dx.doi.org/10.1155/2018/3753479
spellingShingle Ryan J. Hendrix
Paulo N. Martins
Jeffrey S. Stoff
Aaron Ahearn
Adel Bozorgzadeh
Babak Movahedi
Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature
Case Reports in Transplantation
title Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature
title_full Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature
title_fullStr Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature
title_full_unstemmed Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature
title_short Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature
title_sort successful renal transplantation after presumed cyanide toxicity treated with hydroxocobalamin and review of the literature
url http://dx.doi.org/10.1155/2018/3753479
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