Systolic Blood Pressure Pattern: The Tick Mark Signal of Delayed Renal Graft Function

Smudla, Anikó; Trimmel, D.; Szabó, Gábor; Fazakas, János

doi:10.1016/j.transproceed.2019.03.010

Cited by 8 publications

(10 citation statements)

References 15 publications

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“…Adequate organ perfusion, combined with appropriate blood pressure and volume repletion during organ transplantation, is essential to avoid hypoxia, the leading cause of organ dysfunction and damage [ 12 , 16 , 29 ]. The hemodynamic status of the recipient during the transplantation, the time following the transplant, particularly with completion of the anastomosis, and the time point of reperfusion can affect graft perfusion and showed significant influence on short- and long-term outcome and graft function [ 14 , 15 , 16 , 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The hemodynamic status of the recipient during the transplantation, the time following the transplant, particularly with completion of the anastomosis, and the time point of reperfusion can affect graft perfusion and showed significant influence on short- and long-term outcome and graft function [ 14 , 15 , 16 , 19 , 21 ]. Today, it is widely acknowledged and supported by various studies that such perioperative hemodynamic factors can influence the immediate and long-term graft function and outcome [ 12 , 13 , 14 , 15 , 16 , 19 , 21 , 29 , 30 , 31 ]. Consequently, it is of importance to define those hemodynamic monitoring parameters in detail, which correlate with the development of early postoperative complications (e.g., DGF) and consecutively influence long-term graft function and outcome.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Sucher

Schiemanck

Hau

et al. 2022

JCM

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Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas–kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1–10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0–4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Sucher

Schiemanck

Hau

et al. 2022

JCM

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“…During renal transplantation, delayed graft function can occur if the mean arterial pressure (MAP) falls below 70 mmHg. Several studies have recommended maintaining an MAP range of 80-110 mmHg [ 7 , 15 ].…”

Section: Intraoperative Managementmentioning

confidence: 99%

Considerations regarding anesthesia for renal transplantation

Kim,

Jung

2024

Anesth Pain Med

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Renal transplantation is a complex surgical procedure requiring meticulous anesthetic planning to ensure patient safety and optimal graft function. In this comprehensive review, we examined various aspects of anesthesia management during renal transplantation, including preoperative, intraoperative, and postoperative care. Preoperative optimization involves the identification and management of risks to mitigate perioperative complications. Treatment with erythropoiesis-stimulating agents is recommended to correct anemia in transplant recipients with hemoglobin levels below 9–10 g/dl. Intraoperative management focuses on hemodynamic monitoring, maintenance of intravascular volume, and careful selection of anesthetic techniques. Neuromuscular monitoring and the appropriate use of neuromuscular blocking and reversal agents are considered essential. Further, hemodynamic goals include maintaining the mean arterial pressure within the range of 80–110 mmHg. In addition, attention should be paid to perioperative glycemic control, temperature management, and diuretic use. In postoperative management, multimodal analgesia and the prevention of postoperative delirium contribute to optimal recovery. The implementation of enhanced recovery after surgery principles can further improve outcomes. Collaborative efforts among surgical teams, anesthesiologists, and healthcare professionals are crucial for achieving successful renal transplantation outcomes.

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“…Low MAP during reperfusion predisposes the patient to worsened kidney function. In the case of donor and recipient MAP mismatch, the function of the transplanted graft could be also impaired [ 79 , 97 ].…”

Section: Intraoperative Carementioning

confidence: 99%

“…According to a study, kidney recipients who did not require fluid therapy of more than 3000 mL and who had a mean arterial pressure greater than 80 mmHg at the time of transplant reperfusion were less likely to develop DGF [ 107 ]. Excessive fluid therapy should also be avoided during the postoperative period to prevent iatrogenic fluid overload, which leads to further graft damage [ 97 ]. Large volumes lead to other complications, such as pulmonary oedema, infections, myocardial ischaemia, ileus, and increased mortality [ 103 ].…”

Section: Intraoperative Carementioning

confidence: 99%

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

Jaszczuk

Natarajan

Papalois

2022

JCM

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Enhanced recovery after surgery (ERAS) protocols are designed to reduce medical complications, the length of hospital stays (LoS), and healthcare costs. ERAS is considered safe and effective for kidney transplant (KTx) surgery. KTx recipients are often frail with multiple comorbidities. As these patients follow an extensive diagnostic pathway preoperatively, the ERAS protocol can ideally be implemented at this stage. Small singular changes in a long perioperative pathway can result in significant positive outcomes. We have investigated the current evidence for an ERAS pathway related to anaesthetic considerations in renal transplant surgery for adult recipients.

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Systolic Blood Pressure Pattern: The Tick Mark Signal of Delayed Renal Graft Function

Cited by 8 publications

References 15 publications

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Considerations regarding anesthesia for renal transplantation

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

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