Assessment of the Hemostatic Parameters and Platelet Function on Thromboelastometry and Impedance Aggregometry in Hemodialysis Patients Qualified for Kidney Transplantation: Preliminary Report

Pluta, Jan; Nicińska, Barbara; Grzeszczyk, Mirosław; Kołacz, Marcin; Jureczko, Lidia; Kwiatkowski, A.; Durlik, M.; Trzebicki, Janusz

doi:10.1016/j.transproceed.2016.02.057

Cited by 12 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Little is known about perioperative management of platelet dysfunction associated with renal disease, but the finding of increased blood loss is consistent with other studies. 7 , 10 , 11…”

Section: Discussionmentioning

confidence: 99%

Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss: An Observational Cohort Study of 81 Nontraumatic Amputations

Wied

Tengberg

Kristensen

et al. 2017

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction:Underestimation of the actual blood loss in patients undergoing nontraumatic transfemoral amputation (TFA) can impact negatively on outcome in these often frail patients, with very limited physiological reserves. The primary aim of this study is to estimate the total blood loss (TBL) after TFA, and second, to evaluate the impact of blood loss on 30-day mortality and medical complications.Methods:A single-center retrospective cohort study conducted from 2013 to 2015. The TBL was calculated on the fourth postoperative day. It was based on the hemoglobin levels, transfusions, and the estimated blood volume.Results:Eighty-one patients undergoing TFA were included for final analysis. The median TBL was 964 mL (interquartile range [IQR]: 443-1558). The intraoperative blood loss (OBL) was 400 mL (IQR: 200-500). The median difference between TBL and OBL was 688 mL (IQR: 124-1075). The patient received red blood cell (RBC) transfusion of a median amount of 2 units. Higher number of transfusions (>2) did not impact the outcome. From multivariable analysis, it was evident that the TBL increased significantly in patients with renal disease prior to surgery, (P = .034). The TBL itself was not independently associated with increased 30-day mortality or medical complications.Conclusion:The TBL after TFAs is significantly greater than the volume estimated intraoperatively and increases significantly in the presence of renal disease prior to surgery. An increased TBL and requirement for RBC transfusion is not directly associated with 30-day mortality or medical complications. A high vigilance for anemia seems advisable when planning for TFA surgery. Research on optimum blood conservation and transfusion strategies during TFA is warranted.

show abstract

“…Little is known about perioperative management of platelet dysfunction associated with renal disease, but the finding of increased blood loss is consistent with other studies. 7 , 10 , 11…”

Section: Discussionmentioning

confidence: 99%

Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss: An Observational Cohort Study of 81 Nontraumatic Amputations

Wied

Tengberg

Kristensen

et al. 2017

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…The end result of the above intrinsic and extrinsic factors is dysfunctional platelet aggregation and platelet–endothelial interactions. This has been demonstrated in patients with ESRD using platelet aggregation assays in response to different agonists, adenosine diphosphate (ADP), epinephrine, thrombin and collagen [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Successful kidney transplantation normalizes platelet function

Kennedy

Wong

Sexton

et al. 2018

Clinical Kidney Journal

View full text Add to dashboard Cite

BackgroundUraemic platelet dysfunction is not completely understood, in part due to non-physiological platelet function assays. We have developed a physiological flow-based assay that quantifies platelet function in microlitre volumes of blood under arterial shear. The aim of this study was to characterize platelet function before and after kidney transplantation.MethodsTen patients scheduled for living donor kidney transplant surgery and nine healthy controls were analysed using the assay. The motional parameters of platelet behaviour on von Willebrand factor (VWF) were recorded using customized platelet tracking software. The assay was repeated 3–8 weeks post-transplant in the transplant group and at an interval of >3 weeks in normal healthy volunteers.ResultsPlatelet–VWF interactions were markedly reduced in the 10 pre-transplant patients compared with the healthy controls. In seven patients with immediate graft function, dynamic platelet function returned to normal (despite a small decrease in haemoglobin and haematocrit), but remained markedly abnormal in the three patients with delayed graft function (DGF).ConclusionsDynamic platelet function returned to normal following transplantation in those with immediate graft function. This early improvement was not observed in those with DGF. There may be important clinical implications, as patients with DGF are more likely to undergo invasive procedures, including transplant biopsies and insertion of central venous catheters.

show abstract

“…The potential benefit of EDA performed for the transplantation could not be investigated by our study group. In our institution the transplantation itself is performed without EDA due to the mandatory immune suppressive therapy and the high incidence of platelet dysfunction in patients suffering from end stage renal disease [52, 53]. Hadimioglu and colleagues found improved clinical results and an attenuated stress response in kidney transplantations performed with EDA and general anesthesia compared to general anesthesia alone [54].…”

Section: Discussionmentioning

confidence: 99%

Lower rate of delayed graft function is observed when epidural analgesia for living donor nephrectomy is administered

et al. 2019

View full text Add to dashboard Cite

BackgroundThe beneficial effects of epidural analgesia (EDA) in terms of pain control and postoperative convalescence are widely known and led to a frequent use for patients who underwent living donor kidney nephrectomy. The objective of this study was to determine whether general anesthesia (GA) plus EDA compared to GA only, administered for living donor nephrectomy has effects on postoperative graft function in recipients.MethodsIn this monocentric, retrospective cohort analysis we analyzed the closed files of all consecutive donor- recipient pairs who underwent living donor kidney transplantations from 2008 to 2017. The outcome variable was delayed graft function (DGF), defined as at least one hemodialysis within seven days postoperatively, once hyperacute rejection, vascular or urinary tract complications were ruled out. Statistical analyses of continuous variables were calculated using the two-tail Student’s t test and Fisher exact test for categorical variables with a significance level of p < 0.05, respectively.ResultsThe study enclosed 291 consecutive living donor kidney transplantations. 99 kidney donors received epidural analgesia whereas 192 had no epidural analgesia. The groups showed balanced pretransplantational characteristics and comparable donors´ and recipients’ risk factors. 9 out of all 291 recipients needed renal replacement therapy (RRT) during the first 7 days due to delayed graft function; none of these donors received EDA. The observed rate of DGF in recipients whose kidney donors received epidural analgesia was significantly lower (0% vs. 4.6%; p = 0.031).ConclusionsIn our cohort we observed a significantly lower rate of DGF when epidural analgesia for donor nephrectomy was administered. Due to restrictions of the study design this observation needs further confirmation by prospective studies.

show abstract

Assessment of the Hemostatic Parameters and Platelet Function on Thromboelastometry and Impedance Aggregometry in Hemodialysis Patients Qualified for Kidney Transplantation: Preliminary Report

Cited by 12 publications

References 20 publications

Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss: An Observational Cohort Study of 81 Nontraumatic Amputations

Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss: An Observational Cohort Study of 81 Nontraumatic Amputations

Successful kidney transplantation normalizes platelet function

Lower rate of delayed graft function is observed when epidural analgesia for living donor nephrectomy is administered

Contact Info

Product

Resources

About