Öz
Purpose: Delayed graft function (DGF) is a poor clinical prognostic factor in kidney transplantation (KT) which frequently occurs due to acute kidney injury (AKI) within the postoperative first week. In the present study, we researched the effect of SBP (Systolic Blood Pressure) on early graft function after reperfusion in living-donor kidney transplantation.
Materials and methods: We retrospectively obtained preoperative patient clinical data from anesthesia follow-up forms. The research data included demographic data, laboratory data, medical past and kidney-related information. SBP, central venous pressure [CVP], anesthesia duration, infusion and transfusion volumes, blood loss and urine output, surgery duration, ischemia duration and onset of graft diuresis were used as intraoperative data.
Results: There was no significant difference between 4 different systolic blood pressure categories assigned after reperfusion of the kidney in terms of the related characteristics of the recipients. There were significant differences between the 4 groups categorized according to SBP after reperfusion in terms of the related in with intraoperative anesthetic and surgucal variable (p<.001).
Conclusion: Systolic blood pressure over 140 mm Hg after reperfusion may be a safe level regarding long-term graft survival and mortality. It is needed to research the long-term prognosis of living donor kidney transplantation in larger study population to confirm the outcomes of our study.
Anahtar Kelimeler
Blood pressure kidney transplantation perioperative management
Kaynakça
- 1. Kim KM, Kim GS, Han M. A comparative study of pulse pressure variation, stroke volume variation and central venous pressure in patients undergoing kidney transplantation. Singapore Med J 2022;63:731-739. https://doi.org/10.11622/smedj.2021221
- 2. Garg PP, Frick KD, Diener West M, Powe NR. Effect of the ownership of dialysis facilities on patients' survival and referral for transplantation. N Engl J Med 1999;341:1653-1660. https://doi.org/10.1056/NEJM199911253412205
- 3. Neovius M, Jacobson SH, Eriksson JK, Elinder CG, Hylander B. Mortality in chronic kidney disease and renal replacement therapy: a population-based cohort study. BMJ Open 2014;4:e004251. https://doi.org/10.1136/bmjopen-2013-004251
- 4. Sombolos K, Tsakiris D. Has the time come for more flexible organ donation? Kidney Int 2001;59:801-802. https://doi.org/10.1046/j.1523-1755.2001.00560.x
- 5. Helal I, Abderrahim E, Ben Hamida F, et al. The first year renal function as a predictor of long-term graft survival after kidney transplantation. Transplant Proc 2009;41:648-650. https://doi.org/10.1016/j.transproceed.2009.02.036
- 6. Rodrigo E, Fernández Fresnedo G, Ruiz JC, et al. Similar impact of slow and delayed graft function on renal allograft outcome and function. Transplant Proc 2005;37:1431-1432. https://doi.org/10.1016/j.transproceed.2005.02.052
- 7. Tiggeler RG, Berden JH, Hoitsma AJ, Koene RA. Prevention of acute tubular necrosis in cadaveric kidney transplantation by the combined use of mannitol and moderate hydration. Ann Surg 1985;201:246-251. https://doi.org/10.1097/00000658-198502000-00020
- 8. Pascual J, Marcén R, Zamora J, et al. Very early serum creatinine as a surrogate marker for graft survival beyond 10 years. J Nephrol 2009;22:90-98.
- 9. Motayagheni N, Phan S, Eshraghi C, Nozari C, Atala A. A review of anesthetic effects on renal function: potential organ protection. Am J Nephrol 2017;46:380-389. https://doi.org/10.1159/000482014
- 10. Othman MM, Ismael AZ, Hammouda GE. The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation. Anesth Analg 2010;110:1440-1446. https://doi.org/10.1213/ANE.0b013e3181d82ca8
Öz
Amaç: Gecikmiş greft fonksiyonu (DGF), sıklıkla ameliyat sonrası ilk hafta içinde akut böbrek hasarına (AKI) bağlı olarak ortaya çıkan böbrek transplantasyonunda (KT) kötü bir klinik prognostik faktördür. Bu çalışmada canlı donörden böbrek naklinde SKB'nin (sistolik kan basıncı) reperfüzyon sonrası erken greft fonksiyonu üzerine etkisini araştırdık.
Gereç ve yöntem: Hastaların ameliyat öncesi klinik verilerini retrospektif olarak anestezi takip formlarından elde ettik. Araştırma verileri demografik verileri, laboratuvar verilerini, tıbbi geçmişi ve böbrekle ilgili bilgileri içeriyordu. İntraoperatif veriler olarak SKB, santral venöz basınç (CVP), anestezi süresi, infüzyon ve transfüzyon hacimleri, kan kaybı ve idrar çıkışı, ameliyat süresi, iskemi süresi ve greft diürezinin başlangıcı kullanıldı.
Bulgular: Böbrek reperfüzyonu sonrası atanan 4 farklı sistolik kan basıncı kategorisi arasında alıcıların ilgili özellikleri açısından anlamlı bir fark yoktu. Reperfüzyon sonrası SBP'ye göre kategorize edilen 4 grup arasında intraoperatif anestezive cerrahi değişkenler açısından anlamlı fark vardı (p<.001).
Sonuç: Reperfüzyon sonrası sistolik kan basıncının 140 mm Hg'nin üzerinde olması, uzun süreli greft sağkalımı ve mortalite açısından güvenli bir seviye olabilir. Çalışmamızın sonuçlarını doğrulamak için canlı vericiden böbrek naklinin uzun vadeli prognozunun daha geniş çalışma popülasyonunda araştırılması gerekmektedir.
Anahtar Kelimeler
Kaynakça
- 1. Kim KM, Kim GS, Han M. A comparative study of pulse pressure variation, stroke volume variation and central venous pressure in patients undergoing kidney transplantation. Singapore Med J 2022;63:731-739. https://doi.org/10.11622/smedj.2021221
- 2. Garg PP, Frick KD, Diener West M, Powe NR. Effect of the ownership of dialysis facilities on patients' survival and referral for transplantation. N Engl J Med 1999;341:1653-1660. https://doi.org/10.1056/NEJM199911253412205
- 3. Neovius M, Jacobson SH, Eriksson JK, Elinder CG, Hylander B. Mortality in chronic kidney disease and renal replacement therapy: a population-based cohort study. BMJ Open 2014;4:e004251. https://doi.org/10.1136/bmjopen-2013-004251
- 4. Sombolos K, Tsakiris D. Has the time come for more flexible organ donation? Kidney Int 2001;59:801-802. https://doi.org/10.1046/j.1523-1755.2001.00560.x
- 5. Helal I, Abderrahim E, Ben Hamida F, et al. The first year renal function as a predictor of long-term graft survival after kidney transplantation. Transplant Proc 2009;41:648-650. https://doi.org/10.1016/j.transproceed.2009.02.036
- 6. Rodrigo E, Fernández Fresnedo G, Ruiz JC, et al. Similar impact of slow and delayed graft function on renal allograft outcome and function. Transplant Proc 2005;37:1431-1432. https://doi.org/10.1016/j.transproceed.2005.02.052
- 7. Tiggeler RG, Berden JH, Hoitsma AJ, Koene RA. Prevention of acute tubular necrosis in cadaveric kidney transplantation by the combined use of mannitol and moderate hydration. Ann Surg 1985;201:246-251. https://doi.org/10.1097/00000658-198502000-00020
- 8. Pascual J, Marcén R, Zamora J, et al. Very early serum creatinine as a surrogate marker for graft survival beyond 10 years. J Nephrol 2009;22:90-98.
- 9. Motayagheni N, Phan S, Eshraghi C, Nozari C, Atala A. A review of anesthetic effects on renal function: potential organ protection. Am J Nephrol 2017;46:380-389. https://doi.org/10.1159/000482014
- 10. Othman MM, Ismael AZ, Hammouda GE. The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation. Anesth Analg 2010;110:1440-1446. https://doi.org/10.1213/ANE.0b013e3181d82ca8
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi (Diğer), Anesteziyoloji, İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 28 Eylül 2023 |
| Yayımlanma Tarihi | 1 Ekim 2023 |
| Gönderilme Tarihi | 12 Eylül 2023 |
| Kabul Tarihi | 26 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 16 Sayı: 4 |
