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Kim H, Jung H. Considerations regarding anesthesia for renal transplantation. Anesth Pain Med (Seoul) 2024; 19:5-11. [PMID: 38311350 PMCID: PMC10847005 DOI: 10.17085/apm.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024] Open
Abstract
Renal transplantation is a complex surgical procedure requiring meticulous anesthetic planning to ensure patient safety and optimal graft function. In this comprehensive review, we examined various aspects of anesthesia management during renal transplantation, including preoperative, intraoperative, and postoperative care. Preoperative optimization involves the identification and management of risks to mitigate perioperative complications. Treatment with erythropoiesis-stimulating agents is recommended to correct anemia in transplant recipients with hemoglobin levels below 9-10 g/dl. Intraoperative management focuses on hemodynamic monitoring, maintenance of intravascular volume, and careful selection of anesthetic techniques. Neuromuscular monitoring and the appropriate use of neuromuscular blocking and reversal agents are considered essential. Further, hemodynamic goals include maintaining the mean arterial pressure within the range of 80-110 mmHg. In addition, attention should be paid to perioperative glycemic control, temperature management, and diuretic use. In postoperative management, multimodal analgesia and the prevention of postoperative delirium contribute to optimal recovery. The implementation of enhanced recovery after surgery principles can further improve outcomes. Collaborative efforts among surgical teams, anesthesiologists, and healthcare professionals are crucial for achieving successful renal transplantation outcomes.
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Affiliation(s)
- Hyunjee Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hoon Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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2
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Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J 2021; 15:635-643. [PMID: 35371439 PMCID: PMC8967665 DOI: 10.1093/ckj/sfab214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
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Affiliation(s)
- Harry V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajesh Sivaprakasam
- Department of Transplant and Robotic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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3
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Kannan G, Loganathan S, Kajal K, Hazarika A, Sethi S, Sen IM, Subramanyam R, Singh S. The effect of pulse pressure variation compared with central venous pressure on intraoperative fluid management during kidney transplant surgery: a randomized controlled trial. Can J Anaesth 2021; 69:62-71. [PMID: 34750747 DOI: 10.1007/s12630-021-02130-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Traditionally, fluid administration during kidney transplant surgery is guided by central venous pressure (CVP) despite its limited reliability as a parameter for assessing intravascular fluid volume, particularly in patients with cardiovascular diseases. The recommended goals at graft reperfusion are a mean arterial pressure of 90 mm Hg and a CVP of 12-14 mm Hg. This approach may increase the risk of significant adverse effects due to volume overload. Perioperative fluid therapy guided by dynamic indices of fluid responsiveness has been shown to optimize intravascular volume and prevent complications associated with overzealous administration of fluids in major abdominal surgeries. We hypothesized that pulse pressure variation (PPV)-guided fluid administration would result in better optimization of intravascular fluid volume compared with a CVP-guided strategy during kidney transplant surgery. METHODS In this single-centre randomized double blinded trial, 77 end-stage renal disease patients, who underwent kidney transplant surgery under general anesthesia with epidural analgesia, were randomized to receive either CVP-guided (n = 35) or PPV-guided (n = 35) fluid therapy using predefined hemodynamic endpoints. The primary outcome was the total volume of intraoperative fluids administered. Secondary outcomes were intraoperative hemodynamic changes, serum lactate levels, serum creatinine, need for dialysis within the first week, creatinine elimination ratio, and incidence of immediate and delayed graft dysfunction. RESULTS Results were analyzed for 70 patients. Eighty percent of the patients underwent living-related donor allograft kidney transplant. Operative variables related to donor characteristics, duration of surgery, graft cold ischemia time, and blood loss were comparable in both groups. The mean (standard deviation) volume of intravenous fluids administered intraoperatively was 1,346 (337) mL in the PPV-guided group vs 1,901 (379) mL in the CVP-guided group (difference in means, 556 mL; 95% confidence interval, 385 to 727; P = 0.001). There were no significant differences in secondary outcomes between the two groups. CONCLUSION Pulse pressure variation -guided fluid administration significantly decreased the total volume of crystalloids compared with CVP-guided fluid therapy during the intraoperative period in patients who underwent kidney transplant surgery. Nevertheless, our study was underpowered to detect differences in secondary outcomes. TRIAL REGISTRATION www.ctri.nic.in (CTRI/2018/01/011638); registered 31 January 2018.
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Affiliation(s)
- Gowtham Kannan
- Department of Anesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sekar Loganathan
- Department of Anesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Amarjyoti Hazarika
- Department of Anesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Department of Anesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Subramanyam
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarbpreet Singh
- Department of Kidney Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sethi S, Narayan V, Kajal K, Singh S. Continuous wound infusion as an alternative to continuous epidural infusion for postoperative analgesia in renal transplant surgery: A prospective randomized controlled trial. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Kawasaki S, Kiyohara C, Karashima Y, Yamaura K. Blood Pressure Management After Reperfusion in Living-Donor Kidney Transplantation. Transplant Proc 2020; 52:3009-3016. [PMID: 32576473 DOI: 10.1016/j.transproceed.2020.04.1820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/23/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The central focus of anesthesia management in kidney transplantation is to avoid hypotensive episodes and maintain adequate perfusion pressure to the graft. However, it is not clear whether there is an optimal systolic blood pressure (SBP) level after reperfusion for living-donor transplant outcomes. The aim of this study is to investigate the effect of SBP after reperfusion on early graft function in living-donor kidney transplantation. METHODS We retrospectively analyzed 315 patients who underwent living-donor kidney transplantation from January 2013 to December 2017. We divided the patients into 4 groups according to SBP after reperfusion and compared the postoperative estimated glomerular filtration rate and creatinine. RESULTS There were no differences in the postoperative recovery of kidney graft function in the first 7 postoperative days among the 4 SBP groups after reperfusion. However, the urine output after reperfusion was significantly less in the group with SBP < 140 mm Hg after reperfusion compared with the remaining 3 groups in a multivariate analysis (P = .04). CONCLUSIONS No significant differences in early graft function were observed among the 4 SBP groups. SBP ≥ 140 mm Hg after reperfusion, which is linked to greater urine output, can be beneficial in terms of long-term graft survival and mortality.
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Affiliation(s)
- Sho Kawasaki
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chikako Kiyohara
- Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yuji Karashima
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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De Cassai A, Bond O, Marini S, Panciera G, Furian L, Neri F, Andreatta G, Rigotti P, Feltracco P. [Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial]. Rev Bras Anestesiol 2020; 70:194-201. [PMID: 32534731 DOI: 10.1016/j.bjan.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/13/2020] [Accepted: 02/15/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV-guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study. METHODS We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the PPV Group received fluids whenever PPV was higher than 12%, patients in the Free Fluid Group received fluids following our institutional standard care protocol for kidney transplantations (10mL.kg-1.h-1). RESULTS Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge. CONCLUSION PPV-guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.
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Affiliation(s)
- Alessandro De Cassai
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália.
| | - Ottavia Bond
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Silvia Marini
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Giulio Panciera
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Lucrezia Furian
- Padua University Hospital, Department of Surgery, Oncology and Gastroenterology, Kidney and Pancreas Transplant Unit, Pádua, Itália
| | - Flavia Neri
- Padua University Hospital, Department of Surgery, Oncology and Gastroenterology, Kidney and Pancreas Transplant Unit, Pádua, Itália
| | - Giulio Andreatta
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Paolo Rigotti
- Padua University Hospital, Department of Surgery, Oncology and Gastroenterology, Kidney and Pancreas Transplant Unit, Pádua, Itália
| | - Paolo Feltracco
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
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7
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De Cassai A, Bond O, Marini S, Panciera G, Furian L, Neri F, Andreatta G, Rigotti P, Feltracco P. Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32534731 PMCID: PMC9373208 DOI: 10.1016/j.bjane.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study. Methods We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the “PPV” group received fluids whenever PPV was higher than 12%, patients in the “free fluid” group received fluids following our institutional standard care protocol for kidney transplantations (10 mL.kg-1. h-1). Results Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge. Conclusion PPV guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.
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8
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Calixto Fernandes MH, Schricker T, Magder S, Hatzakorzian R. Perioperative fluid management in kidney transplantation: a black box. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:14. [PMID: 29368625 PMCID: PMC5784708 DOI: 10.1186/s13054-017-1928-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/21/2017] [Indexed: 01/14/2023]
Abstract
The incidence of delayed graft function in patients undergoing kidney transplantation remains significant. Optimal fluid therapy has been shown to decrease delayed graft function after renal transplantation. Traditionally, the perioperative volume infusion regimen in this patient population has been guided by central venous pressure as an estimation of the patient’s volume status and mean arterial pressure, but this is based on sparse evidence from mostly retrospective observational studies. Excessive volume infusion to the point of no further fluid responsiveness can damage the endothelial glycocalyx and is no longer considered to be the best approach. However, achievement of adequate flow to maintain sufficient tissue perfusion without maximization of cardiac filling remains a challenge. Novel minimally invasive technologies seem to reliably assess volume responsiveness, heart function and perfusion adequacy. Prospective comparative clinical studies are required to better understand the use of dynamic analyses of flow parameters for adequate fluid management in kidney transplant recipients. We review perioperative fluid assessment techniques and discuss conventional and novel monitoring strategies in the kidney transplant recipient.
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Affiliation(s)
| | - Thomas Schricker
- Department of Anesthesia, Royal Victoria Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Sheldon Magder
- Department of Critical Care Medicine, Royal Victoria Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Roupen Hatzakorzian
- Department of Anesthesia, Royal Victoria Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.,Department of Critical Care Medicine, Royal Victoria Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
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9
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Anesthesia for Kidney Transplantation. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Gonzalez-Castro A, Ortiz-Lasa M, Peñasco Y, González C, Blanco C, Rodriguez-Borregan JC. Elección de fluidos en el periodo perioperatorio del trasplante renal. Nefrologia 2017; 37:572-578. [DOI: 10.1016/j.nefro.2017.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 12/13/2016] [Accepted: 03/16/2017] [Indexed: 12/25/2022] Open
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11
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Sridhar S, Guzman-Reyes S, Gumbert SD, Ghebremichael SJ, Edwards AR, Hobeika MJ, Dar WA, Pivalizza EG. The New Kidney Donor Allocation System and Implications for Anesthesiologists. Semin Cardiothorac Vasc Anesth 2017; 22:223-228. [PMID: 28868984 DOI: 10.1177/1089253217728128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Given potential disparity and limited allocation of deceased donor kidneys for transplantation, a new federal kidney allocation system was implemented in 2014. Donor organ function and estimated recipient survival in this system has implications for perioperative management of kidney transplant recipients. Early analysis suggests that many of the anticipated goals are being attained. For anesthesiologists, implications of increased dialysis duration and burdens of end-stage renal disease include increased cardiopulmonary disease, challenging fluid, hemodynamic management, and central vein access. With no recent evidence to guide anesthesia care within this new system, we describe the kidney allocation system, summarize initial data, and briefly review organ systems of interest to anesthesiologists. As additional invasive and echocardiographic monitoring may be indicated, one consideration may be development of a dedicated anesthesiology team experienced in management and monitoring of complex patients, in a similar manner as has been done for liver transplant recipients.
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Affiliation(s)
| | | | - Sam D Gumbert
- 1 UTHealth McGovern Medical School, Houston, TX, USA
| | | | | | | | - Wasim A Dar
- 1 UTHealth McGovern Medical School, Houston, TX, USA
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12
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Michelet D, Brasher C, Marsac L, Zanoun N, Assefi M, Elghoneimi A, Dauger S, Dahmani S. Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation. Paediatr Anaesth 2017; 27:927-934. [PMID: 28736994 DOI: 10.1111/pan.13201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function. METHODS We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure. The main outcome of the study was the creatinine clearance at day 1 corrected to a body surface area of 1.73 m². Analysis was performed using Classification Tree Analysis with 10-fold cross-validation. RESULTS One hundred and two patients were included. The following predictors of increased postoperative creatinine clearance at day 1 were identified: decreasing recipient weight, mean blood pressure-to-weight ratio 10 minutes after reperfusion, reduced cold ischemia duration, and increased intraoperative albumin infusion. Increased creatinine clearance was observed when mean blood pressure-to-weight ratio 10 minutes after reperfusion was ≥4.3 in patients weighing 13-21 kg and ≥2.5 in those ≥22 kg. Overall, the model explained 64% (and at cross-validation 60%) of creatinine clearance variability at day 1. CONCLUSION Intraoperative hemodynamics during kidney transplantation should be optimized in order to increase mean blood pressure according to values indicated by our analyses. Cold ischemia duration should be shortened as far as possible.
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Affiliation(s)
- Daphné Michelet
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.,Anesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Lucile Marsac
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Nabil Zanoun
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Mona Assefi
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Alaa Elghoneimi
- Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,Department of general and urological surgery, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Stephane Dauger
- Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France.,Departement of Paediatric Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France
| | - Souhayl Dahmani
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
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13
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Intraoperative Management of the Kidney Transplant Recipient. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Affiliation(s)
- Christopher L Wray
- Liver Transplant Division, Liver Transplant Anesthesia Fellowship, Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA.
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Choi JM, Jo JY, Baik JW, Kim S, Kim CS, Jeong SM. Risk factors and outcomes associated with a higher use of inotropes in kidney transplant recipients. Medicine (Baltimore) 2017; 96:e5820. [PMID: 28072739 PMCID: PMC5228699 DOI: 10.1097/md.0000000000005820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Preservation of adequate perfusion pressures to the graft is a main focus of intraoperative management during kidney transplantation. We undertook this study to investigate the incidence of the higher use of inotropes in kidney transplant recipients and identify the patient outcomes and preoperative and intraoperative variables related to this.We retrospectively analyzed 1053 patients who underwent kidney transplantation at Asan Medical Center between January 2006 and February 2012, stratified by their inotropic score ([dopamine] + [dobutamine] + [epinephrine × 100] + [norepinephrine × 100]) <7 versus ≥7, wherein all doses are expressed as μg/kg/min. We evaluated preoperative characteristics, hemodynamic parameters, and intraoperative variables as well as postoperative outcomes, such as length of hospital stay and 1-year rejection and mortality rate.Receiver-operating characteristic analysis was performed to determine inotropic score to predict 1-year mortality. An inotropic score of 7 had the best combined sensitivity and specificity. An inotropic score ≥7 (137 patients, 13.0%) was significantly more prevalent in older patients, those with polycystic kidney disease, and at a 2nd transplant. Anesthesia time, the amounts of crystalloid and 5% albumin infused, and the need for red blood cell transfusion were significantly higher in the inotropic score ≥7 group. The patients with a higher use of inotropes required longer postoperative hospital stay and experienced a >2-fold higher rejection within the 1st year and a 4-fold higher 1-year mortality rate.A higher use of inotropes in kidney transplant recipients is more prevalent in older patients, those with a 2nd transplant and in patients with polycystic kidney disease as their primary renal disease. The postoperative hospital stay, rejection within the 1st year, and 1-year mortality rate are increased in patients with an inotropic score ≥7.
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16
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Snell W, Aronson L, Phillips H, Beale L, Larenza Menzies MP. Influence of anesthetic variables on short-term and overall survival rates in cats undergoing renal transplantation surgery. J Am Vet Med Assoc 2015; 247:267-77. [DOI: 10.2460/javma.247.3.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Lactato de Ringer versus solución salina normal para trasplante renal. Revisión sistemática y metaanálisis. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rca.2015.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Trujillo-Zea JA, Aristizábal-Henao N, Fonseca-Ruiz N. Lactated Ringer's vs. normal saline solution for renal transplantation: Systematic review and meta-analysis. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Aulakh NK, Garg K, Bose A, Aulakh BS, Chahal HS, Aulakh GS. Influence of hemodynamics and intra-operative hydration on biochemical outcome of renal transplant recipients. J Anaesthesiol Clin Pharmacol 2015; 31:174-9. [PMID: 25948896 PMCID: PMC4411829 DOI: 10.4103/0970-9185.155144] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND AIMS Early graft function is crucial for successful kidney transplantation. The aim of our study was to evaluate the effect of intra-operative central venous pressure (CVP) and mean arterial pressure (MAP) on early graft function and biochemical outcome. MATERIAL AND METHODS This was a retrospective study carried out on patients undergoing renal transplant only from live-related donors between March 2011 and May 2013. We mainly divided the patients into two groups based on CVP and mean MAP. One group had CVP more than 12 and other with CVP <12 mmHg at the time of declamping. Further one group was with mean MAP >100 mmHg and other with mean MAP of <100 mmHg. The graft outcome of genetically related and genetically unrelated donors was also evaluated in early postoperative period. The trend in fall of serum creatinine was studied during the first five post-operative days. The effect of age, dry weight, sex, relation with donor and intraoperative factors like MAP and CVP on early graft function were analysed. Correlation analysis, analysis of variance test (ANOVA) and multivariate analysis technique were used in this study for statistical computation. RESULTS The mean CVP at the time of declamping was 13.91 mmHg. The minimum CVP was 6 mmHg in one patient who had ischemic heart disease with low ejection fraction. All 5 days mean serum creatinine values were comparable in two groups on 1(st), 2(nd), 3(rd) and 4(th) postoperative days. The mean MAP at the time of declamping was 111.22 mmHg. Mean MAP varied from a minimum of 95 mmHg to maximum of 131 mmHg. There was no significant difference in two groups on 1(st), 2(nd), 3(rd), 4(th) and 5(th) postoperative days. CONCLUSION A CVP around 12 mmHg and mean MAP >95 mmHg with good perioperative fluid hydration is associated with good early graft function.
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Affiliation(s)
- Navpreet Kaur Aulakh
- Department of Biochemistry, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kamakshi Garg
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, India
| | - Abhishek Bose
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Baldev Singh Aulakh
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, India
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Sood A, Ghosh P, Jeong W, Khanna S, Das J, Bhandari M, Kher V, Ahlawat R, Menon M. Minimally Invasive Kidney Transplantation. Transplantation 2015; 99:316-23. [DOI: 10.1097/tp.0000000000000590] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lactated Ringerʼs vs. normal saline solution for renal transplantation: Systematic review and meta-analysis☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543030-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gulyam Kuruba SM, Mukhtar K, Singh SK. A randomised controlled trial of ultrasound-guided transversus abdominis plane block for renal transplantation. Anaesthesia 2014; 69:1222-6. [DOI: 10.1111/anae.12704] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | - K. Mukhtar
- St. Helens and Knowsley Teaching Hospitals NHS Trust; Prescot UK
| | - S. K. Singh
- Royal Liverpool and Broad Green University Hospitals NHS Trust; Liverpool UK
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Su MW, Chang SS, Chen CH, Huang CC, Chang SW, Tsai YC, Lam CF. Preconditioning renoprotective effect of isoflurane in a rat model of virtual renal transplant. J Surg Res 2014; 189:135-42. [PMID: 24674838 DOI: 10.1016/j.jss.2014.02.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The development of warm-cold ischemia-reperfusion (IR) injury of the kidney grafts is inevitable during renal transplantation. However, there is currently no definite renoprotective strategy available in the protection of the graft tissue. In the present study, we compared the renal protection of preconditioning isoflurane with N-acetylcysteine (NAC) in a novel rat model of warm-cold renal IR injury. MATERIALS AND METHODS Adult Sprague-Dawley rats were randomly assigned to receive inhaled isoflurane (1.5% for 2 h), NAC (1 g/kg, intra-arterial injection) or placebo before the induction of brief warm ischemia (10 min) followed by cold ischemia (45 min) periods. Plasma levels of creatinine and tissue inflammatory reaction in the kidney were analyzed 72 h after reperfusion. RESULTS Elevated plasma level of creatinine and urea indicated the development of acute renal injury secondary to IR injury. The creatinine levels were reduced in animals pretreated with inhaled isoflurane and NAC, and the level was more significantly decreased in the isoflurane-treated group. Preconditioning with volatile isoflurane also significantly suppressed the tissue myeloperoxidase activity and expression of the inducible nitric oxide synthase. Immunostaining confirmed that myeloperoxidase expression was most significantly attenuated in the glomerulus and peritubular capillaries of rats pre-exposed to isoflurane. CONCLUSIONS We present the first study demonstrating that the administration of volatile isoflurane before induction of experimental warm-cold renal IR injury provides preconditioning renoprotective effect, which is superior to the treatment with NAC. The beneficial renoprotective effect of isoflurane is most likely mediated by attenuation of proinflammatory reaction in the injured kidney.
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Affiliation(s)
- Min-Wen Su
- Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Shen-Shin Chang
- Department of Surgery, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Chung-Hao Chen
- Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Chien-Chi Huang
- Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Shih-Wei Chang
- Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Yu-Chuan Tsai
- Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Department of Anesthesiology, Buddhist Tzu-Chi General Hospital and Tzu-Chi University School of Medicine, Hualien, Taiwan.
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Hirata ES, Pereira RIC, Filho GA, Braga ADFA. Hyperkalemia by Euro-Collins solution in anesthesia for renal transplantation: a case report. Rev Bras Anestesiol 2013; 63:429-32. [PMID: 24263050 DOI: 10.1016/j.bjan.2012.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 08/20/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe anesthesia for renal transplantation that progressed to a sharp potassium increase after kidney reperfusion with Euro-Collins' solution in the operative field. We will also report on diagnosis and treatment used. CONCLUSION The use of infusion solutions in the surgical field requires careful monitoring, such as electrocardiography, measurement of serum potassium, and availability of calcium gluconate, insulin, and albuterol for immediate use. The replacement of Euro-Collins' solution for saline solution immediately before the implant may be a useful option in patients with high levels of potassium.
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Affiliation(s)
- Eunice Sizue Hirata
- Departamento de Anestesiologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
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Abstract
INTRODUCTION Renal transplantation (RT) is considered the treatment of choice for patients with end-stage renal disease due to the improved short- and long-term survival benefits over dialysis treatment. The success of RT can be improved by working within a multidisciplinary team. OBJECTIVE The aim of this work was to assess the anesthetic management of RT to guarantee success. DISCUSSION Anesthesiologists who work in RT should know the interactions between hemodynamics and pharmacology in these patients. But to be able to work as a team, there are three questions that need to be answered: What do the urologist and the anesthesiologist need to know about renal transplantation? What does the urologist need to know about anesthesia? Or, in other words, what do anesthesiologists really want the urologists to know, and what does an anesthesiologist want to know about RT? CONCLUSIONS RT is a complex procedure that needs a multidisciplinary approach, especially in patients with important comorbidities. It is necessary to learn how to look through the eyes of the rest of the team. Working within a multidisciplinary team is basic to ensure the success of the RT.
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Tallman K, Ramachandran SK, Christensen R, O’Brien D. Cardiac Arrest in the PACU: An Analysis of Evolving Challenges for Perianesthesia Nursing. J Perianesth Nurs 2011; 26:4-8. [DOI: 10.1016/j.jopan.2010.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 09/15/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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