Prevention of Fluid Effusion in Kidney Transplantation With the Use of Hemostatic Biomaterials

Tammaro, Vincenzo; Vernillo, A.; Dumani, Xh.; Florio, I; Pelosio, Luigi; Jamshidi, Akbar; Romagnuolo, R.; Calogero, Armando; Carlomagno, Nicola; Santangelo, Michele; Renda, Andrea

doi:10.1016/j.transproceed.2014.07.048

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…Several preventive measures have been proposed to reduce lymphocele formation (reviewed in Ref. ) including meticulous ligation of lymphatic vessels at the time of surgery in both donor and recipient , compression therapy of the lower extremities , haemostatic/polymeric sealants , drains and certain immunosuppressive regimes . Peritoneal fenestration has been proposed as a simple surgical method to reduce post‐KTx lymphocele formation.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the immunosuppressive regime seems to influence the rate of lymphoceles and appropriate adaptation can reduce the risk . Some authors have used polymeric sealants/haemostatic biomaterial or povidone‐iodine to reduce lymphocele formation; however, these methods either lack high‐quality evidence, are not cost‐effective or did not significantly decrease post‐KTx lymphoceles. The use of drains to prevent lymphocele formation is controversial .…”

Section: Introductionmentioning

confidence: 99%

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Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review

et al. 2017

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Lymphocele formation after kidney transplantation is a frequent complication which causes pain, secondary graft loss, rehospitalizations and reoperations. Therefore, prophylaxis of lymphocele formation is of utmost importance. To assess the effectiveness of peritoneal fenestration in renal transplantation to prevent lymphocele development. A systematic literature search was conducted combined with hand-searches on lymphocele prevention following renal transplantation using peritoneal fenestration. A qualitative and quantitative analysis of included trials was conducted. We identified three trials including 414 patients and 437 transplantations which studied peritoneal fenestration. Only one randomized controlled trial was identified. Critical appraisal uncovered a number of methodological flaws, predominantly in the nonrandomized studies. Most importantly endpoint definitions varied among trials, selection bias was high and interventions and follow-up were not standardized. Meta-analysis of the included trials showed a significant reduction of clinically symptomatic lymphoceles (OR: 0.23, 95% CI: 0.09-0.64, P = 0.005) and overall postoperative fluid collections (OR: 0.49, 95% CI: 0.28-0.88, P = 0.02) without a significant increase in other surgical complications. Although peritoneal fenestration is a promising technique to reduce lymphocele formation, only few studies have investigated this technique so far. Given the low methodological quality of included trials, more studies are necessary to evaluate the effectiveness and the risks and benefits of this technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review

et al. 2017

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“…5,6 Postoperative fluid collection around the transplanted kidney can also have considerable influence both on outcome and on functional recovery of the graft. 7 Therefore, achieving hemostasis during renal transplant is particularly important in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have demonstrated a shorter time of hemostasis and surgery with the use of biomaterials. 7 While these biomaterials differ in their composition, all are applied directly to the site of action and trigger the coagulation cascade or form a mechanical barrier to prevent effusion. Synthetic agents act independently of the coagulation cascade and use a monomer cross-linker to bind to tissue.…”

Section: Introductionmentioning

confidence: 99%

A prospective, randomized, pilot trial of a polyethylene glycol (PEG)-coated collagen patch (Hemopatch®) for intraoperative hemostasis during deceased donor renal transplant

Kapoor

Wong

Vasisth

et al. 2019

CUAJ

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Introduction: The objective of this study was to evaluate the safety and feasibility of using a polyethylene glycol (PEG)-coated collagen patch (Hemopatch®) in patients undergoing deceased donor renal transplant. The primary outcome was the amount of intraoperative estimated blood loss in those patients receiving the patch compared to without. Secondary outcomes were the subjective achievement of hemostasis, perigraft collection, and drop in hemoglobin 48 hours postoperatively. Methods: We performed a single-center, prospective, randomized trial. Patients scheduled to undergo deceased donor renal transplant surgery were randomized to receive the PEG-coated patch or standard hemostasis (i.e., electrocautery and clips). Results: A total of 30 patients were enrolled over 15 months and randomized to receive the PEG-coated patch (n=15) or standard hemostasis (n=15). The mean age was 62.5 years. As determined by the operating surgeon, hemostasis was successfully achieved in all 15 cases using the PEG-coated patch. In the PEG-coated patch group, there was a trend towards less estimated blood loss (237 cc vs. 327 cc; p=0.11) and a lower drop in hemoglobin 48 hours postoperatively (22.27 g/L vs. 29.53 g/L; p=0.09) compared to the standard hemostasis group. Perigraft collection was similar between groups (27% vs. 40%; p=0.43). Subgroup analysis on patients who received anticoagulation therapy revealed no significant difference in blood loss between groups. Conclusions: Based on our single-center experience, the PEG-coated patch (Hemopatch®) is a safe and feasible option to aid hemostasis during deceased donor renal transplant surgery. Hemostasis was successfully achieved in all cases using the PEG-coated patch.

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“…However, they may result in morbidities such as abdominal discomfort, impaired wound healing, thrombosis and even graft loss due to pressure on the kidney, the ureter or vascular structure. 2 7 Because of the frequency and consequences of post-KTx lymphoceles, different preventive methods have been proposed in the literature 1 3 such as: precise ligation of donor and recipient lymphatic vessels, 2 drains at the site of graft implantation, 8 polymeric sealants/haemostatic biomaterials, 9 10 povidone-iodine, 11 compression of the lower limb after KTx, 12 intraoperative fluorescent lymphography 13 and intraoperative bipolar cautery of lymphatic vessels. 14 However, post-KTx lymphocele formation still remains a challenging complication that requires long-term postoperative interventions.…”

Section: Introductionmentioning

confidence: 99%

PREventive effect of FENestration with and without clipping on post-kidney transplantation lymphatic complications (PREFEN): study protocol for a randomised controlled trial

et al. 2020

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IntroductionPeritoneal fenestration is an effective preventive method for reducing the rate of lymphatic complications in kidney transplantation (KTx). The size of the fenestration plays an important role in its effectiveness. A large peritoneal window is no longer indicated, due to herniation and difficulties in performing biopsies. Small preventive fenestration is effective but will be closed too early. The aim of this study is to evaluate whether metal clips around the edges of a small fenestration result in optimal effects with minimum fenestration size.Methods and analysisThis trial has been initiated in July 2019 and is expected to last for 2 and a half years. All patients older than 18 years, who receive kidneys from deceased donors, will be included. The kidney recipients will be randomly allocated to either a control arm (small fenestration alone) or an intervention arm (small fenestration with clipping). All fenestrations will be round, maximum 2 cm, and close to the kidney hilum. Clipping will be performed with eight metal clips around the peritoneal window (360°) in every 45° in an oblique position. The primary endpoint is the incidence of symptomatic post-KTx lymphatic complications, which require interventional treatment within 6 months after KTx. Secondary endpoints are intraoperative and postoperative outcomes, including blood loss, operation time, severity grade of lymphocele/lymphorrhea and relative symptoms.Ethics and disseminationThis protocol study received approval from the Ethics Committee of the University of Heidelberg (Registration Number S-318/2017). A Standard Protocol Items: Recommendations for Interventional Trials checklist is available for this protocol. The results will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT03682627).

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Prevention of Fluid Effusion in Kidney Transplantation With the Use of Hemostatic Biomaterials

Cited by 11 publications

References 14 publications

Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review

Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review

A prospective, randomized, pilot trial of a polyethylene glycol (PEG)-coated collagen patch (Hemopatch®) for intraoperative hemostasis during deceased donor renal transplant

PREventive effect of FENestration with and without clipping on post-kidney transplantation lymphatic complications (PREFEN): study protocol for a randomised controlled trial

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