Pulmonary Thromboendarterectomy Enabling Renal Transplantation in Patient of Chronic Kidney Disease: A Case Report

Abstract

Pulmonary endarterectomy (PEA) is a surgical treatment approach for the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The surgery is considered high risk in terms of mortality and morbidity. We present here a patient at high operative risk due to severe pulmonary hypertension (PH) and chronic renal failure (CKD). The 22-year-old male patient was undergoing hemodialysis treatment for three years due to bilateral hydronephrosis-induced CKD, and was admitted to the hospital with increasing dyspnea. The diagnosis of CTEPH was made clinically and radiologically. During the follow-up period, an endarterectomy was planned, although the patient was considered high risk due to insufficient clinical response, despite medical therapy. Bilateral PEA was applied by thoracic surgery team. sPAP decreased from 105 to 35 mmHg on echocardiography, and dyspnea was improved and functional capacity recovered after the PEA surgery. A renal transplantation was contraindicated in the preoperative period due to severe pulmonary arterial hypertension. PEA surgery was enabled to patient kidney transplantation due to an improvement in pulmonary functions and pulmonary artery pressure. We present here a case of CTEPH who had achance of kidney transplantation after undergoingsuccessful PEA surgery.