Efficacy of Biphasic Fluid Therapy in Robot-Assisted Kidney Transplantation

Year 2023, Volume: 15 Issue: 3, 125 - 138, 30.09.2023

Nalan Saygı Emir

https://doi.org/10.54233/endouroloji.20231503-1345663

Abstract

Objective: Perioperative fluid treatment is among the factors affecting transplant kidney function. In this
study, the efficacy of biphasic fluid treatment on per-operative patient stabilization and allograft kidney
functions were evaluated.
Material and Methods: Data of 65 robotic living releated donor kidney transplantation performed between
2015-2017 were retrospectively analyzed (16/04/2018, Protocol no 2018-07-13). The patients were divided as
preemptive (Group Preemptif: GP, n=27) and non-preemptive group (Group Non-Preemptif: GNP, n=38).
Biphasic fluid treatment was used in all cases (Phase 1 = before-vascular anastomosis 1-3 ml/kg/h and phase
2 = after-vascular anastomosis 10-12 ml/kg/h, respectively). Hemodynamic and biochemical status of the
patients, early and late allograft kidney function were evaluated. Datas were statistically compared within
and between the groups.
Results: Hemodynamic/metabolic stability and diuresis were achieved after vascular anastomosis in all
patients. There was no difference in the total amount of iv fluid given between the groups, except that the
amount of fluid given in phase 1 was significantly less in GP (p<0.05). Pre-operative blood pH and HCO3
values were lower, Na+ and Cl- values were higher in GP(p<0.05). No difference was found in K+ and Ca+2
values at all times and pH values after extubation in both groups. Pre-operative blood urea and creatinine
levels were significantly higher in GP (p<0.05) but all decreased to normal on postoperative 1 and 7 days. In
long-term follow-up, both groups had similar mortality and rejection rates.
Conclusion: Our results support that biphasic fluid treatment is effective to achieve hemodynamic/
metabolic stability and allograft kidney functions in robotic living releated kidney transplantation patients.

Keywords

Anesthesia, Fluid Therapy, Hemodynamic monitoring, Kidney transplantation, Transplant recipient, Robot-assisted surgery

Robot Yardımlı Böbrek Naklinde Bifazlı Sıvı Tedavisi’nin Etkinliği

Abstract

Amaç: Perioperatif sıvı tedavisi, nakledilen böbreğin işlevini etkileyen faktörlerden biridir. Bu çalışmada,
perioperatif hasta stabilizasyonu ve allograft böbrek fonksiyonları üzerine ikili fazlı sıvı tedavisinin etkinliği
değerlendirilmiştir.
Gereç ve Yöntemler: 2015-2017 yılları arasında gerçekleştirilen 65 canlı vericili robot yardımlı laparoskopik
böbrek nakli operasyonu verileri retrospektif olarak analiz edildi (16/04/2018, Protokol no 2018-07-13).
Hastalar nakil öncesi diyaliz tedavisi alan grup (Grup Preemptif: GP, n=27) ve nakil öncesi diyaliz tedavisi
almayan grup (Grup Non-Preemptif: GNP, n=38) olarak bölündü. Tüm vakalarda ikili fazlı sıvı tedavisi kullanıldı
(faz 1=vasküler anastomoz öncesi 1-3 ml/kg/s ve faz 2=vasküler anastomoz sonrası 10-12 ml/kg/s). Hastaların
hemodinamik ve biyokimyasal durumu, erken ve geç allograft böbrek fonksiyonları değerlendirildi. Veriler
istatistiksel olarak gruplar içinde ve arasında karşılaştırıldı.
Bulgular: Tüm hastalarda vasküler anastomoz sonrasında hemodinamik/metabolik stabilite ve diürez elde
edildi. Gruplar arasında intravenöz (iv) sıvı toplam miktarında (faz 1’de verilen miktar dışında) fark yoktu,
ancak GP’de faz 1’ de verilen sıvı miktarı anlamlı olarak daha azdı (p<0,05). Ameliyat öncesi kan pH ve HCO3
değerleri GP’de düşüktü, Na+ ve Cl- değerleri yüksekti (p<0,05). K+ ve Ca+2 değerlerinde her zaman ve
her iki grupta ekstübasyon sonrası pH değerlerinde fark bulunmadı. Ameliyat öncesi kan üre ve kreatinin
düzeyleri GP’de anlamlı olarak yüksekti (p<0,05), ancak tüm değerler ameliyat sonrası 1. ve 7. günlerde
normale döndü. Uzun süreli takipte, her iki grupta da benzer mortalite ve reddetme oranları görüldü.
Sonuç: Sonuçlarımız, canlı vericili robot yardımlı laparoskopik böbrek nakli hastalarında ikili fazlı sıvı
tedavisinin hemodinamik/metabolik stabilite ve allograft böbrek fonksiyonlarını elde etmede etkili
olduğunu desteklemektedir.

Keywords

Anestezi, Sıvı tedavisi, Hemodinamik izleme, Böbrek nakli, Nakil alıcısı, Robot yardımlı cerrahi

Ethical Statement

Bakirkoy Dr. Sadi Konuk Training and Research Hospital Clinical Studies Ethics Committee Decision Form 13.07.2018218/60

References

• 1. Sprung J, Kapural L, Bourke DL et al. Anesthesia for kidney transplant surgery. Anesthesiol Clin North Am. 2000;18(4):919-51. https://doi.org/10.1016/s0889-8537(05)70202-9. PMID:11094698.
• 2. Ratner LE, Buell JF, Kuo PC. Laparoscopic donor nephrectomy: pro. Transplantation. 2000 Nov 27;70(10):1544-6. https://doi.org/10.1097/00007890-200011270-00029. PMID:11118108.
• 3. Neuberger JM, Bechstein WO, Kuypers DR et al. Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation. 2017;101(4S Suppl 2):S1-S56. https://doi.org/10.1097/TP.0000000000001651. PMID:28328734.
• 4. Wagener G, Bezinover D, Wang C et al. Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists. Transplantation. 2021 Aug 1;105(8):1677-1684. https://doi.org/10.1097/TP.0000000000003581. PMID:33323765.
• 5. Tuğcu V, Şener NC, Şahin S et al. Robotic kidney transplantation: The Bakırköy experience. Turk J Urol. 2016;42(4):295-298. https://doi.org/10.5152/tud.2016.12369. PMID:27909625; PMCID:PMC5125746.
• 6. Slagter JS, Outmani L, Tran KTCK et al. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: A systematic review and meta-analyses. Int J Surg. 2022;99:106264. https://doi.org/10.1016/j.ijsu.2022.106264. Epub 2022 Feb 17. PMID:35183735.
• 7. Snoeijs MG, Wiermans B, Christiaans MH et al. Recipient hemodynamics during non-heart-beating donor kidney transplantation are major predictors of primary nonfunction. Am J Transplant. 2007;7(5):1158-66. doi: 10.1111/j.1600-6143.2007.01744.x. Epub 2007 Feb 27. PMID:17331108.
• 8. Campos L, Parada B, Furriel F et al. Do intraoperative hemodynamic factors of the recipient influence renal graft function? Transplant Proc. 2012;44(6):1800-3. https://doi.org/10.1016/j.transproceed.2012.05.042. PMID:22841277.
• 9. İ. İnce Et Al. , "Anaesthetic experience of 200 renal transplantation cases: A retrospective study," Abant Medical Journal. vol.5, no.2, pp.118-126, 2016.
• 10. Debout A, Foucher Y, Trébern-Launay K et al. Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney Int. 2015 Feb;87(2):343-9. https://doi.org/10.1038/ki.2014.304. Epub 2014 Sep 17. PMID:25229341.
• 11. Kyllönen LE, Salmela KT, Eklund BH et al. Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection. Transpl Int. 2000;13(2):122-8. https://doi.org/10.1007/s001470050295. PMID:10836648.
• 12. Ojo AO, Hanson JA, Wolfe RA et al. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57(1):307-13. https://doi.org/10.1046/j.1523-1755.2000.00816.x. PMID:10620213.
• 13. Prommool S, Jhangri GS, Cockfield SM et al. Time dependency of factors affecting renal allograft survival. J Am Soc Nephrol. 2000;11(3):565-573. https://doi.org/10.1681/ASN.V113565. PMID: 10703681.
• 14. Yee J, Parasuraman R, Narins RG. Selective review of key perioperative renal-electrolyte disturbances in chronic renal failure patients. Chest. 1999;115(5 Suppl):149S-157S. https://doi.org/10.1378/chest.115.suppl_2.149s. PMID:10331349.
• 15. Snoeijs MG, Wiermans B, Christiaans MH et al. Recipient hemodynamics during non-heart-beating donor kidney transplantation are major predictors of primary nonfunction. Am J Transplant. 2007;7(5):1158-66. https://doi.org/10.1111/j.1600-6143.2007.01744.x. Epub 2007 Feb 27. PMID:17331108.
• 16. Lu CY, Penfield JG, Kielar ML et al. Hypothesis: is renal allograft rejection initiated by the response to injury sustained during the transplant process? Kidney Int. 1999 Jun;55(6):2157-68. https://doi.org/10.1046/j.1523-1755.1999.00491.x. PMID:10354265.
• 17. Calixto Fernandes MH, Schricker T, Magder S et al. Perioperative fluid management in kidney transplantation: a black box. Crit Care. 2018 Jan 25;22(1):14. https://doi.org/10.1186/s13054-017-1928-2. PMID:29368625; PMCID:PMC5784708.
• 18. Russo A, Marana E, Viviani D et al. Diastolic function: the influence of pneumoperitoneum and Trendelenburg positioning during laparoscopic hysterectomy. Eur J Anaesthesiol. 2009;26(11):923-7. https://doi.org/10.1097/EJA.0b013e32832cb3c9. PMID:19696680.
• 19. Joris JL, Chiche JD, Canivet JL et al. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998;32(5):1389-96. https://doi.org/10.1016/s0735-1097(98)00406-9. PMID:9809953.
• 20. Antonini B, Piva S, Paltenghi M et al. The early phase of critical illness is a progressive acidic state due to unmeasured anions. Eur J Anaesthesiol. 2008;25(7):566-71. https://doi.org/10.1017/S0265021508003669. Epub 2008 Mar 13. PMID:18339216.
• 21. Witczak BJ, Leivestad T, Line PD et al. Experience from an active preemptive kidney transplantation program--809 cases revisited. Transplantation. 2009 Sep 15;88(5):672-7. https://doi.org/ 10.1097/TP.0b013e3181b27b7e. PMID:19741464.
• 22. Liem YS, Weimar W. Early living-donor kidney transplantation: a review of the associated survival benefit. Transplantation. 2009 Feb 15;87(3):317-8. https://doi.org/10.1097/TP.0b013e3181952710. PMID:19202433.
• 23. Cueto-Manzano AM, Morales-Buenrostro LE, González-Espinoza L et al. Markers of inflammation before and after renal transplantation. Transplantation. 2005 Jul 15;80(1):47-51. https://doi.org/10.1097/01.tp.0000164348.16689.03. PMID:16003232.
• 24. Schnuelle P, Johannes van der Woude F. Perioperative fluid management in renal transplantation: a narrative review of the literature. Transpl Int. 2006;19(12):947-59. https://doi.org/10.1111/j.1432-2277.2006.00356.x. PMID:17081224.
• 25. Hadimioglu N, Saadawy I, Saglam T et al. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesth Analg. 2008;107(1):264-9. https://doi.org/10.1213/ane.0b013e3181732d64. PMID:18635497.
• 26. Pfortmueller C, Funk GC, Potura E et al. Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantation: Prospective, randomized, controlled trial. Wien Klin Wochenschr. 2017;129(17-18):598-604. https://doi.org/10.1007/s00508-017-1180-4. Epub 2017 Mar 2. PMID:28255797; PMCID:PMC5599439.
• 27. O'Malley CM, Frumento RJ, Bennett-Guerrero E. Intravenous fluid therapy in renal transplant recipients: results of a US survey. Transplant Proc. 2002;34(8):3142-5. https://doi.org/10.1016/s0041-1345(02)03593-5. PMID:12493402.
• 28. Adwaney A, Randall DW, Blunden MJ et al. Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study. Clin Kidney J. 2017;10(6):838-844. https://doi.org/10.1093/ckj/sfx040. Epub 2017 Jun 29. PMID:29225814; PMCID:PMC5716220.
• 29. González-Castro A, Ortiz-Lasa M, Rodriguez-Borregan JC et al. Influence of Proportion of Normal Saline Administered in the Perioperative Period of Renal Transplantation on Kalemia Levels. Transplant Proc. 2018;50(2):569-571. https://doi.org/10.1016/j.transproceed.2017.06.040. PMID:29579854.