Case reportCochlear implantation after renal transplantation☆
Introduction
Cochlear implantation has become a widely used method of auditory rehabilitation in carefully selected surgical candidates with severe to profound hearing loss. In recent years, otologists have been making strides toward implanting candidates with chronic medical conditions, such as organ transplant recipients on long-term immunosuppressant medications, who were previously excluded because of their significant medical comorbidities and surgical risk [1], [2], [3]. In particular, patients with chronic renal failure who subsequently undergo renal transplantation represent a group with an inherently increased incidence of sensorineural hearing loss but for which cochlear implantation is, as of yet, uncommon [4], [5], [6], [7], [8]. The inherent risk is typically either a congenital otorenal genetic disturbance or because of drugs with potential ototoxic properties administered commonly to patients with renal failure [8].
Patients taking long-term immunosuppressants and immunomodulators represent a surgical challenge because of the potential for increased risk of postoperative complications. As this therapy attenuates the inflammatory process, the potential for wound dehiscence or other wound healing issues poses challenges for the surgeon [9]. Infection becomes a particular concern in transplant patients not only because the surgical approach inherently places them at risk for meningitis, but the implantation of hardware also carries a risk of infection [10], [11], [12].
This manuscript seeks to add to the small but growing body of evidence that cochlear implantation in this population of renal transplant patients with inherent indications is feasible for properly selected patients with appropriate perioperative management despite their inherent risks.
Section snippets
Materials and methods
A retrospective chart review was performed on patients receiving cochlear implantation in a tertiary academic medical center between 2006 and 2009. Two patients with renal failure who had previously obtained a renal transplant were identified. After submission to the institutional review board, the board determined that the investigation qualified for exemption. Chart documentation was reviewed and reported. Open-set sentence and word discrimination were measured by the Hearing in Noise Test
Case 1
A 47-year-old Caucasian woman underwent a living-related renal transplantation in 2001 secondary to chronic pyelonephritis after 10 months on hemodialysis. This was complicated by short-term rejection. Five years later, during a prolong intensive care admission for urosepsis, she received several ototoxic medications including vancomycin and furosemide and developed profound sensorineural hearing loss that was not responsive to steroid therapy. Preimplantation speech awareness thresholds were
Discussion
Before this report, the literature described 8 cochlear implants in 6 patients who had undergone solid organ transplantation. Four of the patients received renal transplantation [1], [2]. The case reported by Cortina et al [2] describes a 4-year-old boy with congenital renal dysplasia who underwent a living-related kidney transplant at age 2 years. He had sensorineural hearing loss that was attributed to ototoxic antibiotic medications and long-term loop diuretic use. Twenty months after his
Conclusion
This study adds to the growing evidence that, in appropriately selected renal transplant patients, successful cochlear implantation can be achieved. Decision making should rely on surgical candidacy as well as assessment of surgical risk in collaboration with the transplant service.
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Cited by (0)
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Funding: None. Financial disclosures: Dr McKinnon was a consultant for MED-EL until June 2009. The consulting agreement is no longer in force. Poster presented at the 7th Asia-Pacific Symposium on Cochlear Implants and Related Sciences, Singapore, December 2009. Poster discussing the review of the literature for cochlear implants in renal transplant patients presented at the 11th International Conference on Cochlear Implants and Other Implantable Auditory Technologies, Stockholm, Sweden, July 2010.