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Yang SM, Song SE, Jung JY, Ju JW, Sohn JY, Lee HJ, Kim WH. Comparison of two different preload targets of stroke volume variation during kidney transplantation: a randomised controlled trial. Singapore Med J 2024:00077293-990000000-00146. [PMID: 39267428 DOI: 10.4103/singaporemedj.smj-2023-150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 09/13/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION Maintaining adequate preload during kidney transplantation (KT) is important for graft function. We evaluated whether a high or low normal target for a dynamic preload index of stroke volume variation (SVV) would impact graft function during living donor KT. METHODS We compared haemodynamic management algorithms using two different targets of SVV: SVV6% group (n = 30) versus SVV12% group (n = 30). Crystalloids were administered to achieve SVV less than the assigned target. Neutrophil gelatinase-associated lipocalin (NGAL) level at the end of surgery was compared. We also compared the incidence of delayed graft function (DGF), daily serum creatinine level and glomerular filtration rate (GFR) until 2 weeks postoperatively. RESULTS The total amount of crystalloids administered was significantly different between the SVV6% and SVV12% groups (median [interquartile range] 2,250 [1,700-3,600] vs. 1,350 [1,050-1,900], P < 0.001). There was no significant difference in NGAL level at the end of the operation between the SVV6% and SVV12% groups (395 [234-560] vs. 518 [346-654], P = 0.115). The incidence of DGF was not significantly different, and there was no significant difference in the postoperative serum creatinine levels or GFR between the groups. CONCLUSIONS Our randomised trial demonstrated that an SVV target of either 6% or 12% could be adequate as a preload management target for postoperative graft function during living donor KT. However, given the low incidence of DGF in living donor KT and type II error, our study should be interpreted carefully and further studies for deceased donor KT are required.
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Affiliation(s)
- Seong-Mi Yang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Eun Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Yoon Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Reimold P, Aksoy C, Beckmann J, Zacharis A, Groeben C, Karschuck P, Eisenmenger N, Geks J, Huber J, Flegar L. Development and outcomes of surgical and urological kidney transplantation programs in Germany: a total population analysis from 2006 to 2021. World J Urol 2024; 42:65. [PMID: 38300367 PMCID: PMC10834564 DOI: 10.1007/s00345-023-04740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/08/2023] [Indexed: 02/02/2024] Open
Abstract
PURPOSE Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. METHODS On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals' quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). RESULTS A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (- 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (- 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. CONCLUSION KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.
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Affiliation(s)
- Philipp Reimold
- Department of Urology, Philipps-University Marburg, Marburg, Germany.
| | - Cem Aksoy
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Jonas Beckmann
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Josef Geks
- Department of Surgery, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
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Wagener G, Bezinover D, Wang C, Kroepfl E, Diaz G, Giordano C, West J, Kindscher JD, Moguilevitch M, Nicolau-Raducu R, Planinsic RM, Rosenfeld DM, Lindberg S, Schumann R, Pivalizza EG. Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists. Transplantation 2021; 105:1677-1684. [PMID: 33323765 DOI: 10.1097/tp.0000000000003581] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intraoperative fluid management may affect the outcome after kidney transplantation. However, the amount and type of fluid administered, and monitoring techniques vary greatly between institutions and there are limited prospective randomized trials and meta-analyses to guide fluid management in kidney transplant recipients. METHODS Members of the American Society of Anesthesiologists (ASA) committee on transplantation reviewed the current literature on the amount and type of fluids (albumin, starches, 0.9% saline, and balanced crystalloid solutions) administered and the different monitors used to assess fluid status, resulting in this consensus statement with recommendations based on the best available evidence. RESULTS Review of the current literature suggests that starch solutions are associated with increased risk of renal injury in randomized trials and should be avoided in kidney donors and recipients. There is no evidence supporting the routine use of albumin solutions in kidney transplants. Balanced crystalloid solutions such as Lactated Ringer are associated with less acidosis and may lead to less hyperkalemia than 0.9% saline solutions. Central venous pressure is only weakly supported as a tool to assess fluid status. CONCLUSIONS These recommendations may be useful to anesthesiologists making fluid management decisions during kidney transplantation and facilitate future research on this topic.
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Affiliation(s)
| | | | - Cynthia Wang
- Greater Los Angeles VA Healthcare System, Los Angeles, CA
| | | | | | | | - James West
- Methodist-LeBonheur Healthcare Memphis, TN
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Vieira RF, Carmona MJC. Volemia and kidney transplantation. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32811621 PMCID: PMC9373450 DOI: 10.1016/j.bjane.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Roberta Figueiredo Vieira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Programa de Anestesia em Transplante Renal, São Paulo, SP, Brasil.
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Perioperative considerations for kidney and pancreas-kidney transplantation. Best Pract Res Clin Anaesthesiol 2020; 34:3-14. [PMID: 32334785 DOI: 10.1016/j.bpa.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/16/2019] [Accepted: 01/06/2020] [Indexed: 01/28/2023]
Abstract
Kidney transplantation is the treatment of choice in patients with end-stage renal disease, as it improves survival and quality of life. Living donor kidney transplant prior to pancreas transplantation, or simultaneous pancreas and kidney transplantation are discussed. Patients usually present comorbidities and extensive preoperative workups are recommended, especially cardiac assessment, though type and frequency of surveillance is not established. Nephroprotective strategies include adequate fluid status and goal-directed therapy. The conventional use of diuretics has not demonstrated a real nephroprotective effect at follow-up. Thromboprophylaxis regimes, especially for the pancreatic graft outcome, are of importance. Notably, transplantation in the obese population has increased in recent decades. Strict preoperative evaluation and pulmonary considerations must be kept in mind. Finally, robotic kidney transplant is a recent approach that presents anesthetic challenges, mainly related to steep Trendelenburg position and fluid restriction.
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Kaufmann KB, Baar W, Silbach K, Knörlein J, Jänigen B, Kalbhenn J, Heinrich S, Pisarski P, Buerkle H, Göbel U. Modifiable Risk Factors for Delayed Graft Function After Deceased Donor Kidney Transplantation. Prog Transplant 2019; 29:269-274. [PMID: 31167610 DOI: 10.1177/1526924819855357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Delayed graft function is a major complication after kidney transplantation affecting patients' long-term outcome. The aim of this study was to identify modifiable risk factors for delayed graft function after deceased donor kidney transplantation. METHODS This is a single-center retrospective cohort study of a university transplantation center. Univariate and multivariate step-wise logistic regression analysis of patient-specific and procedural risk factors were conducted. RESULTS We analyzed 380 deceased donor kidney transplantation patients between October 30, 2008 and December 30, 2017. The incidence of delayed graft function was 15% (58/380). Among the patient-specific risk factors recipient diabetes (2.8 [1.4-5.9] odds ratio [OR] [95% confidence interval [CI]]), American Society of Anesthesiologist score of 4 (2.7 [1.2-6.5] OR [95% CI]), cold ischemic time >13 hours (2.8 [1.5-5.3] OR [95% CI]) and donor age >55 years (1.9 [1.01-3.6] OR [95% CI]) revealed significance. The significant intraoperative, procedural risk factors included the use of colloids (3.9 [1.4-11.3] OR [95% CI]), albumin (3.0 [1.2-7.5] OR [95% CI]), crystalloids >3000 mL (3.1 [1.2-7.5] OR [95% CI]) and mean arterial pressure <80 mm Hg at the time of reperfusion (2.4 [1.2-4.8] OR [95% CI]). CONCLUSION Patients undergoing deceased donor kidney transplantation with a mean arterial pressure >80 mm Hg at the time of transplant reperfusion without requiring excessive fluid therapy in terms of colloids, albumin or crystalloids >3000 mL are less likely to develop delayed graft function.
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Affiliation(s)
- Kai B Kaufmann
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Wolfgang Baar
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Kai Silbach
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Julian Knörlein
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Bernd Jänigen
- 2 Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Johannes Kalbhenn
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Sebastian Heinrich
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Przemyslaw Pisarski
- 2 Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Hartmut Buerkle
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Ulrich Göbel
- 1 Department of Anesthesiology and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine-University of Freiburg, Freiburg, Germany
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