Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 18, 2022; 12(4): 65-71
Published online Apr 18, 2022. doi: 10.5500/wjt.v12.i4.65
Renal transplantation in gigantism: A case report
Jeevan Prakash Gopal, Sotirios Charalampidis, Jinpo Xiang, Frank J M F Dor, Vassilios E Papalois
Jeevan Prakash Gopal, Sotirios Charalampidis, Frank J M F Dor, Vassilios E Papalois, Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
Jinpo Xiang, Imperial College School of Medicine, Imperial College, London W12 0HS, United Kingdom
Frank J M F Dor, Vassilios E Papalois, Department of Surgery and Cancer, Imperial College, London W12 0HS, United Kingdom
Author contributions: Gopal JP, Charalampidis S and Xiang J wrote the manuscript; Gopal JP revised the manuscript; Papalois VE performed the transplant; Papalois VE and Dor FJMF made critical corrections to the manuscript; all the authors reviewed and approved the final version.
Informed consent statement: The patient has provided informed consent prior to the procedure and publication.
Conflict-of-interest statement: We declare no conflict of interest.
CARE Checklist (2016) statement: The CARE checklist has been followed and statement is provided.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeevan Prakash Gopal, MBBS, MS, Surgeon, Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom. jeevan.gopal@nhs.net
Received: March 11, 2021
Peer-review started: March 11, 2021
First decision: June 7, 2021
Revised: July 7, 2021
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: April 18, 2022
Processing time: 397 Days and 20.8 Hours
Abstract
BACKGROUND

Gigantism, characterized by excessive growth and height is due to increased secretion of growth hormone, most commonly from a pituitary adenoma. In addition to the surgical and anesthetic complexity, the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single or dual kidney transplantation. The lack of relevant literature further adds to the dilemma.

CASE SUMMARY

A 45-year-old patient with untreated gigantism and end stage renal failure on renal replacement therapy was waitlisted for a deceased donor dual kidney transplantation due to the extreme physical stature (Height-247 cm and weight-200 kg). He was offered 2 kidneys from a 1-0-1 HLA mismatched 24-year-old DCD donor (Height-179 cm and weight-75 kg), and was planned for a bilateral retroperitoneal implantation into the recipient external iliac vessels. The immunosuppression consisted of alemtuzumab induction (50 mg) and steroid-free maintenance with tacrolimus. The donor’s right kidney was uneventfully implanted extra-peritoneally into the right external iliac vessels. On contralateral exposure, the left common and external iliac arteries were ectatic and frail. A complex vascular reconstruction was not preferred in order to preserve the arterial supply to the left lower limb, to minimise the cold ischemia time and prevent additional warm ischemic insult to the second kidney. Hence, it was decided not to proceed with dual transplantation. Amidst concerns of nephron mass insufficiency, the graft function was remarkable with a serum creatinine of 120 µmol/L within a month from transplantation and 94 µmol/L at 1-year post transplantation, and without proteinuria.

CONCLUSION

To our knowledge, this is the first case report on kidney transplantation in gigantism. Although it is believed that dual kidney transplantation is ideal, a single kidney transplantation from an appropriately selected donor can provide sufficient functioning nephron mass in patients with gigantism.

Keywords: Gigantism; Giantism; Renal transplantation; Kidney transplantation; Pituitary adenoma; Case report

Core Tip: We report a patient with untreated pituitary gigantism with end stage renal failure due to IgA nephropathy with secondary focal segmental glomerular sclerosis who underwent a successful deceased donor kidney transplantation. We have described the intra-operative challenges in deciding whether to proceed with a single kidney transplantation or dual kidney transplantation. To the best of our knowledge this is the first case report on kidney transplantation in gigantism.