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Song J, Yao Y, He Y, Lin S, Pan S, Zhong M. Contrast-Enhanced Ultrasonography Value for Early Prediction of Delayed Graft Function in Renal Transplantation Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:201-210. [PMID: 35603734 DOI: 10.1002/jum.16010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/11/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Delayed graft function (DGF) is a common early complication after kidney transplantation. The aim of the present study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the early prediction of DGF after kidney transplantation. METHODS A total of 89 renal transplant recipients were retrospectively enrolled and divided into DGF group or normal graft function (NGF) group according to the allograft function. Conventional Doppler ultrasound and CEUS examination data on the first postoperative day were collected and analyzed. RESULTS The resistive indices of segmental and interlobar artery in the DGF group were significantly higher than those in the NGF group (0.71 ± 0.17 versus 0.63 ± 0.08, P = .006; 0.70 ± 0.16 versus 0.62 ± 0.08, P = .004, respectively). The patients experiencing DGF had significantly lower PI-c (14.7 dB ± 6.1 dB versus 18.5 dB ± 3.3 dB, P = .001) and smaller AUC-c (779.8 ± 375.8 dB·seconds versus 991.0 ± 211.7 dB·seconds, P = .003), as well as significantly lower PI-m (12.6 dB ± 5.9 dB versus 15.9 dB ± 3.9 dB, P = .006), shorter MTT-m (30.7 ± 9.4 seconds versus 36.3 ± 7.1 seconds, P = .01), and smaller AUC-m (P = .007). Multivariate analysis demonstrated that PI-c, AUC-c, and MTT-m were independent risk factors for DGF. The area under the receiver operating characteristic curve values of the combined predicted value (PI-c + MTT-m, PI-c + AUC-c + MTT-m) of DGF incidence were bigger than that of PI-c, AUC-c, or MTT-m. CONCLUSIONS CEUS parameters of the cortex and medulla have a good value for an early prediction of DGF after renal transplantation.
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Affiliation(s)
- Jieqiong Song
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Yao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yizhou He
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shilong Lin
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Simeng Pan
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Rajmohan N, Omkarappa S, Srinivasan SP, Nair SG, Rajgopal R, Eldo N. Anesthetic Challenges and Perioperative Factors Affecting Delayed Graft Function in Robotic-Assisted Kidney Transplant: A Review of a Single-Center Experience of 100 Cases. Cureus 2022; 14:e28957. [PMID: 36237794 PMCID: PMC9547721 DOI: 10.7759/cureus.28957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective The advent of robot-assisted kidney transplant (RAKT) has ushered in a new set of challenges. In this single-center retrospective observational study, we aimed to highlight the anesthetic challenges and analyze perioperative parameters to identify the risk factors for delayed graft function (DGF) in RAKT. Methods A descriptive analysis of perioperative factors of the first 100 cases of RAKT at our center was performed. Data were retrieved from the hospital's electronic medical records (EMR) of donors and adult patients who underwent RAKT between July 2015 and December 2020. The data analyzed included demographics, preoperative optimization, intraoperative and postoperative management, and complications. DGF was defined as a requirement of dialysis within one week of transplant. The Fisher’s exact test, independent sample t-test, and the Mann-Whitney test were used to analyze data. Results Among a total of 193 renal transplants performed during the study period, 100 patients underwent RAKT, which included 27 females and 73 males. Of these, 91 were live while the remaining involved deceased-donor transplants. Pneumoperitoneum and steep Trendelenburg position required various “anesthetic maneuvers” to maintain hemodynamics and respiratory parameters. Optimal fluid management, with frusemide and mannitol, ensured good urine output (UOP) (93%). Post-reperfusion, the release of pneumoperitoneum, maintenance of adequate perfusion pressures, immunosuppression, and regional hypothermia helped in ensuring adequate graft function (93%). The incidence of DGF in our series was 7% and the mortality rate was 3%. Recipient age (p=0.045), dyslipidemia (p=0.021), and diabetes mellitus (p=0.023) were identified as significant risk factors for DGF. Conclusion Advanced recipient age, diabetes, and dyslipidemia were factors significantly associated with DGF in RAKT in our series of 100 cases. However, the duration of the steep Trendelenburg position, docking of robot/pneumoperitoneum (console time), fluid management, warm and cold ischemia times, rewarming time, and type of graft did not influence DGF. Awareness of the systemic involvement in RAKT, proper preoperative optimization, and knowledge of potential problems are essential for the efficient anesthetic management of RAKT.
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Ha NTT, Van Manh B, Dung NTT, Kien TQ, Van Duc N, Van DT, Ha DM, Kien NT, Tiep TD, Quyet D, Toan PQ, Tien TV, Thang LV. Long Hemodialysis Duration Predicts Delayed Graft Function in Renal Transplant Recipients From Living Donor: A Single-Center Study. Transplant Proc 2021; 53:1477-1483. [PMID: 34006381 DOI: 10.1016/j.transproceed.2021.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aims to determine the ratio of delayed graft function in renal transplant recipients from living donors and the predictive value of hemodialysis time before transplant for delayed graft function. METHODS We conducted a study on 116 adult patients who were diagnosed with end-stage kidney disease and were treated with hemodialysis and transplanted kidneys from living donors for 2 years (from June 2018 to June 2020). Delayed graft function event was collected for each patient. RESULTS The recipients had a median age of 36.5 years old, in which 55.2% of them were men, 4.3% of them had the diabetic mellitus, and the median hemodialysis duration was 6 months. The ratio of positive panel-reactive antibody was 33.6% and vascular reconstruction of the donor's kidney was 16.4%. The ratio of delayed graft function was 12.2% (14 of 116 patients). Delayed graft function significantly related to positive panel-reactive antibody, long duration of hemodialysis before transplant, and vascular reconstruction of donor's kidney with P < .001. Duration of hemodialysis before kidney transplant had a predictive value for delayed graft function (area under the curve, 0.83; P < .001). CONCLUSION Delayed graft function was not rare in renal transplant recipients from living donors. Duration of hemodialysis before kidney transplant was a good predictor for delayed graft function.
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Affiliation(s)
- Nguyen Thi Thu Ha
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Bui Van Manh
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Nguyen Thi Thuy Dung
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Truong Quy Kien
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Nguyen Van Duc
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Diem Thi Van
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Do Manh Ha
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Nguyen Trung Kien
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Tran Dac Tiep
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Do Quyet
- Vietnam Military Medical University, Ha Noi, Vietnam
| | - Pham Quoc Toan
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Tran Viet Tien
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam
| | - Le Viet Thang
- Military Hospital 103, Ha Noi, Vietnam; Vietnam Military Medical University, Ha Noi, Vietnam.
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Kreimann K, Jang MS, Rong S, Greite R, von Vietinghoff S, Schmitt R, Bräsen JH, Schiffer L, Gerstenberg J, Vijayan V, Dittrich-Breiholz O, Wang L, Karsten CM, Gwinner W, Haller H, Immenschuh S, Gueler F. Ischemia Reperfusion Injury Triggers CXCL13 Release and B-Cell Recruitment After Allogenic Kidney Transplantation. Front Immunol 2020; 11:1204. [PMID: 32849490 PMCID: PMC7424013 DOI: 10.3389/fimmu.2020.01204] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
Ischemia reperfusion injury (IRI) is linked with inflammation in kidney transplantation (ktx). The chemokine CXCL13, also known as B lymphocyte chemoattractant, mediates recruitment of B cells within follicles of lymphoid tissues and has recently been identified as a biomarker for acute kidney allograft rejection. The goal of this study was to explore whether IRI contributes to the up-regulation of CXCL13 levels in ktx. It is demonstrated that systemic levels of CXCL13 were increased in mouse models of uni- and bilateral renal IRI, which correlated with the duration of IRI. Moreover, in unilateral renal IRI CXCL13 expression in ischemic kidneys was up-regulated. Immunohistochemical studies revealed infiltration of CD22+ B-cells and, single-cell RNA sequencing analysis a higher number of cells expressing the CXCL13 receptor CXCR5, in ischemic kidneys 7 days post IRI, respectively. The potential relevance of these findings was also evaluated in a mouse model of ktx. Increased levels of serum CXCL13 correlated with the lengths of cold ischemia times and were further enhanced in allogenic compared to isogenic kidney transplants. Taken together, these findings indicate that IRI is associated with increased systemic levels of CXCL13 in renal IRI and ktx.
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Affiliation(s)
- Kirill Kreimann
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Mi-Sun Jang
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Song Rong
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Robert Greite
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | | | - Roland Schmitt
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Lena Schiffer
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | | | - Vijith Vijayan
- Institute for Transfusion Medicine, Hannover Medical School (MHH), Hannover, Germany
| | | | - Li Wang
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Christian M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Stephan Immenschuh
- Institute for Transfusion Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
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