#4880 SUCCESSFUL LIMB SALVAGE IN A CHALLENGING PATIENT ON DIALYSIS BY IMPLANTATION OF AUTOLOGOUS PERIPHERAL BLOOD MONONUCLEAR CELLS: A CASE REPORT

Abstract

Abstract Background and Aims Peripheral arterial disease (PAD) is an extremely common condition in patients with End-Stage Renal Disease (ESRD) on dialysis. Concomitant comorbidity such as diabetes may be associated with complex vascular dysfunction, and ESRD itself is a recognized risk factor for PAD leading to non healing ulcers and lower limb amputation, which occurs in a high rate of patients [1]. Despite improvement in endovascular techniques for lower extremity revascularization, the incidence of limb salvage among dialysis patients remains poor. Furthermore, lower extremity amputation in these patients is associated with higher mortality rates [2], in addition to important social and economic implications. In this Case Report, an emergent therapy approach was applied aiming to limb salvage in a 74 years old female patient on hemodialysis suffering from lower extremity critical ischemia in diabetic foot infection, otherwise candidate for major amputation, after ineffective angioplasty and Negative Pressure Wound Therapy (NPWT). Method After surgical debridement of the ischemic lesion, an innovative therapeutic approach [3] was performed. It consisted in implantation, in the perilesional area of the affected lower limb, of a concentrate of autologous peripheral blood mononuclear cells (PBMNC) taken from 120 ml of peripheral blood of the patient, by using a selective filtration separation system. This procedure was managed in the operating room and was repeated three times at intervals of 15 days from each other. Since concomitant osteomyelitis occurs in the ischemical diabetic foot under treatment, it was managed with a 2-dose regimen of weekly Dalbavancin, reaching infection control. The patient was followed twice a week for 7 months for regular medications. Results After the treatment approach, the granulation tissue improved gradually, obtaining complete surgical wound healing. Since toes gangrene occurs, amputation of the toes was necessary, but limb rescue was successfully reached. Conclusion The autologous implantation of PBMNC resulted in limb salvage in this patient on dialysis affected by critical peripheral arterial disease in diabetic foot. This approach has not been described in literature among patients on dialysis, despite the higher mortality rate associated with lower limb amputation in these patients. It seems to be a very promising therapy, with the potential to modify the natural history of no-options critical limb with diabetes complications, in terms of major amputation and overall survival rates. After thorough validation, the reported management could be considered for similar cases.