An Effective Cooling Device for Minimal-Incision Kidney Transplantation

Comprehensive Overview of Innovative Strategies in Preventing Renal Ischemia-reperfusion Injury: Insights from Bibliometric and In silico Analyses

BACKGROUND

Ischemia-reperfusion Injury (IRI) is a complex pathophysiological process with severe consequences, including irreversible loss of renal function. Various intraoperative prevention methods have been proposed to mitigate the harmful effects of warm ischemia and kidney reperfusion.

AIM

This comprehensive analysis provides an overview of pharmacological agents and intraoperative methods for preventing and treating renal IRI.

METHODS

Our analysis revealed that eplerenone exhibited the highest binding affinity to crucial targets, including Aldehyde Dehydrogenase (AD), Estrogen Receptor (ER), Klotho protein, Mineralocorticoid Receptor (MR), and Toll-like Receptor 4 (TLR4). This finding indicates eplerenone's potential as a potent preventive agent against IRI, surpassing other available therapeutics like Benzodioxole, Hydrocortisone, Indoles, Nicotinamide adenine dinucleotide, and Niacinamide. In preventing kidney IRI, our comprehensive analysis emphasizes the significance of eplerenone due to its strong binding affinity to key targets involved in the pathogenesis of IRI.

RESULTS

This finding positions eplerenone as a promising candidate for further clinical investigation and consideration for future clinical practice.

CONCLUSION

The insights provided in this analysis will assist clinicians and researchers in selecting effective preventive approaches for renal IRI in surgical settings, potentially improving patient outcomes.

Systematic review of techniques and devices used to avoid warm ischemia time injury during kidney transplantation

PURPOSE

The lack of a reliable and reproducible technique to ensure a constantly low temperature of the graft during kidney transplantation (KT) may be a cause of renal nonfunction. The aim of this review was to assess all the methods and devices available to ensure hypothermia during vascular anastomosis in KT.

METHODS

A literature search was conducted through May 2022 using PubMed/Medline, Cochrane Library, Embase and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The review protocol was registered on PROSPERO (CRD42022326550).

RESULTS

A total of 20 studies reporting on four hypothermia techniques met our inclusion criteria. Simple instillation of cold serum is not sufficient, the graft reaching up to 33 ℃ at the end of warm ischemia time (WIT). Plastic bags filled with ice slush have questionable efficiency. The use of a gauze jacket filled with ice-slush was reported in 12/20 studies. It ensures a graft temperature up to 20.3 ℃ at the end of WIT. Some concerns have been linked to potentially inhomogeneous parenchymal cooling and secondary ileus. Novel devices with continuous flow of ice-cold solution around the graft might overcome these limitations, showing a renal temperature below 20 ℃ at all times during KT.

CONCLUSION

The gauze filled with ice slush is the most common technique, but several aspects can be improved. Novel devices in the form of cold-ischemia jackets can ensure a lower and more stable temperature of the graft during KT, leading to higher efficiency and reproducibility.

Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: A systematic review and meta-analyses

BACKGROUND

Robot-assisted kidney transplantation (RAKT) has emerged as an alternative for kidney transplant recipients with the potential benefits of minimally invasive surgery. The aim of this systematic review and meta-analysis is to compare the clinical outcomes of RAKT with open kidney transplantation (OKT).

METHODS

MEDLINE, Embase, Web of Science and Cochrane databases were systematically searched. Baseline characteristics, intraoperative and postoperative outcomes were collected, as well as long-term renal function and data on graft and patient survival.

RESULTS

Eleven studies were included, which compared 482 RAKT procedures with 1316 OKT procedures. RAKT was associated with lower a risk of surgical site infection (Risk ratio (RR) = 0.15, p < 0.001), symptomatic lymphocele (RR = 0.20, p = 0.03), less postoperative pain (Mean difference (MD) = -1.38 points, p < 0.001), smaller incision length (MD = -8.51 cm, p < 0.001), and shorter length of hospital stay (MD = -1.69 days, p = 0.03) compared with OKT. No difference was found in renal function, graft, and patient survival.

CONCLUSIONS

RAKT is a safe and feasible alternative to OKT with less surgical complications without compromising renal function, graft and patient survival.

Laparoscopic Orthotopic Kidney Transplantation in Swine: A Novel Vascular Prop Device for Venous Anastomoses

Objective: To investigate the safety and efficacy of a vascular prop device for laparoscopic orthotopic kidney transplantation (LOKT) in swine.

Material and Methods: Twenty swine were randomly divided into two groups. A vascular prop device was used in the observation (VP) group, and the vein beltization technique was used in the control (VB) group. The right kidney, as a donor graft, was laparoscopically transplanted to the location of the left kidney after a left nephrectomy. Data on the operative time, venous anastomotic time, vein stenosis, etc., and the survival of the swine in the two groups were recorded.

Results: The mean transplant operative time, the mean cold ischemia time, and the venous anastomotic times in the VP group were significantly shorter than those in the VB group. Seven swine in the VP group and three swine in the VB group survived for 7 days. Autopsy results showed the occurrence of one artery stenosis and one vein stenosis in the VP group and one artery stenosis and five vein stenoses in the VB group. The median survival time was 6.25 days for the swine in the VP group and 4.40 days for those in the VB group.

Conclusions: The vascular prop device is safe and feasible for LOKT in swine and may accelerate venous anastomosis and ensure the quality of venous anastomotic stoma.