Preemptive Kidney Transplantation in a Pediatric Patient With Factor XI Deficiency: A Case Report.
Ghina Sadek, Chakib Khoury, Farah Ghobar et al.
✦ AI-curated · Sources linked
Case in brief
A 14-year-old boy with end-stage renal disease from congenital posterior urethral valves underwent preemptive living-donor heterotopic kidney transplantation from his brother. He had factor XI activity of 10% and markedly prolonged activated partial thromboplastin time, but no history of bleeding. A multidisciplinary perioperative plan included two units of fresh frozen plasma and no antifibrinolytic agents. Transplantation was uneventful, with minimal blood loss and immediate graft function. Coagulation parameters normalized after surgery before gradually returning to baseline, and renal function remained stable during follow-up.
What made this case unusual
The report describes pediatric preemptive kidney transplantation in a patient with factor XI deficiency, a combination the authors note had not previously been reported in a child.
Diagnostic / clinical pearl
Factor XI activity and activated partial thromboplastin time do not necessarily predict bleeding history; perioperative planning for major surgery should account for the individual clinical context.
Why it matters
This case shows that factor XI deficiency need not automatically preclude kidney transplantation, while highlighting the need for further evidence to guide perioperative management.