Background: End-stage renal disease patients on dialysis typically have an advanced disease status and many cardiovascular complications. We aimed to compare the intraoperative hemodynamics between non-preemptive (with preoperative dialysis) and preemptive (without preoperative dialysis) recipients of living donor kidney transplantation (LDKT). Methods: This was a single center retrospective study. The recipients of LDKT were included and all data were collected by electronic medical record. Recipients were divided in two groups: preemptive and non-preemptive kidney transplantation. After comparing the potential risk factors between two groups, we performed a propensity score-matching analysis to reduce the differences of baseline characteristics. The primary outcome was intraoperative hemodynamic events such as the prevalence of the intraoperative hypotension; electrolyte; frequency of inotropes or vasopressors use; and acid-base status. Secondary outcome was immediate graft function by nadir creatinine (Cr), time to nadir Cr. Estimated blood loss, surgical time, postoperative bleeding and re-operation were also investigated. Results: We analyzed data from 541 patients after propensity score matching: 388 and 153 patients in non-preemptive and preemptive groups, respectively. The multivariable analysis revealed the AUT of the preemptive group was significantly greater than those of non-preemptive group at thresholds absolute 70 and more inotropes and vasopressors were administered to the preemptive group. Furthermore, base excess in the preemptive group was lower than non-preemptive group. Postoperative nadir Cr concentration, the time to nadir Cr were not different between two groups significantly. Estimated blood loss, surgical time, postoperative bleeding, re-operation were also not different between two groups. Conclusions: Intraoperative hypotension and acidosis occurred more frequently in recipients without preoperative dialysis during LDKT. With this finding in mind, anesthesiologists should prepare for situations where intraoperative hypotension may occur.
Background: The number of patients relisting on kidney transplantation (KT) wait list due to prior allograft loss is increasing which accounts for 9.2% according to the Korean Network for Organ Sharing (KONOS) data. Therefore, this study is designed to understand the outcomes of second KT compared to first KT as the needs for repeat transplantation are increasing. Methods: Data were collected retrospectively for 1,429 living donor KT, performed from 1995-2020 at Samsung Medical Center. Demographics of recipients and donors, immunologic factors and outcomes of retransplantation group were compared to first transplant. Primary outcomes are death-censored graft survival and patient survival. Results: Among 1,429 cases, first KT were 1,355 and second KT were 74. Five-and 10-year graft survival of patients with first KT are 94.26% and 83.54%, those of second KT are 96.12% and 85.95%, showing no statistically significant differences (P=0.3988). Five-year patient survival of first KT was 97.7% and that of second KT was 96.27%, and 10-year survival of first KT was 94.22% and that of second KT was 92.57%, which show no statistically significant differences (P=0.7657). This study analyzed changes of serum creatinine after transplantation for 10 years to evaluate trends of graft function over time. As time goes, serum creatinine levels of both groups were tended to increased, however, there was no significant differences in rate of changes between two groups. Multivariate analysis confirmed that age of donor (hazard ratio [HR], 1.0289) and number of mismatched human leukocyte antigen (HLA) class II (HR, 1.634) increase risk of graft failure. Age of recipient, diabetes mellitus (recipient), hypertension (donor), and number of HLA class II mismatch are associated with higher risk of mortality. History of previous transplantation was not a risk factor of any outcomes. Conclusions: This study revealed that repeat renal transplantation with living donor kidney offers comparable graft and patient survival to first transplantation. Therefore, repeat KT with living donor is reasonable treatment of choice.
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