Acute facial oedema post live-donor renal transplantation

Abstract

Facial oedema leading to airway compromise immediately after surgery is a rare event. We report a case of acute facial swelling sufficient to cause a significant obstruction of the patient's airway in recovery. We believe it was caused by partial obstruction of the venous drainage from the head associated with a sudden and large fluid load. A 35-year-old man underwent a live ABO-incompatible renal transplantation during which a central line was inserted into the right subclavian vein and a large volume of fluid was given intraoperatively. He also had a longstanding permacatheter on the left side used for haemodialysis. In the recovery room he developed acute facial swelling which did not resolve with steroids or antihistamines. He was managed by intubation of his airway and ventilation in the intensive care unit overnight before he made a complete recovery with no further intervention. We hypothesise that this event was related to an impaired venous return from his head secondary to the central venous line and the permacatheter partially obstructing the venous drainage from his head and neck combined with an acute large venous fluid load.