A 53-Year-Old Man Who Underwent Living Donor Kidney Transplant Had Right Femoral Vein Thrombosis, Right Internal Iliac Artery AtheromatousPlaque, Ischemic Reperfusion Injury, Acute Kidney Injury, Septicemia, Septic Shock Due to Burkholderia Cepacia, Metabolic Acidosis, Adult Respiratory Distress Syndrome, Ischemic Heart Disease and Diabetic Autonomic Neuropathy: Multiplication of Drops!

A 53-year-old man was on maintenance hemodialysis with right permanent catheter for 2 years because of non-functioning arterio-venous fistular (AVF). He had long standing diabetes mellitus with autonomic neuropathy. Right femoral vein and internal iliac vein were found to be thrombosed during living donor kidney transplant. Donor-renal vein was connected to right external iliac vein. Anastomosis of donor’s renal artery to right external iliac artery was done because of atheromatous plaque at right internal iliac artery. Revision of venous anastomosis was done due to venous out flow obstruction noticed during ureter anastomosis. It resulted in longer total ischemic time, 45 minutes, and caused ischemic reperfusion injury. Intraoperative blood pressure varied 95/60 mmHg to 110/70 mmHg with two inotropes. It was complicated by septic shock, metabolic acidosis, adult respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Though antibiotics, triple inotropes, hemodiafiltration and ventilatory support were tried, the patient could not make it. Blood culture obtained 5 days after death revealed Burkholderia cepacia.