Erişkin canlı donör ve kadavra donör böbrek nakillerinde alıcıların intraoperatif hemodinamik parametrelerinin karşılaştırılması

Abstract

Amaç: Böbrek nakli anestezisi ile ilgili çok sayıda çalışma yapılmıştır ancak verici tipine göre intraoperatif parametreler açısından literatürde yeterli veri bulunmamaktadır. Bu çalışmada canlı donör ve kadavra donör böbrek nakli (BN) yapılan erişkin hastalarda intraoperatif hemodinamik parametreleri karşılaştırmayı amaçladık.

Gereç ve Yöntemler: BN yapılan hastalar verici böbrek tipine göre 2 gruba ayrıldı. Kadavra donör nakli yapılan alıcılar Grup 1 olarak çalışmaya dahil edildi. Canlı verici böbrek nakli yapılanlar arasında, Grup 1 ile benzer demografik verilere sahip aynı sayıda alıcı belirlendi ve Grup 2’ye dahil edildi. Her iki grup kaydedilen veriler ve intraoperatif hemodinamik parametreler açısından karşılaştırıldı.

Bulgular: Çalışmaya 24 hasta dahil edildi. Ortalama diyaliz süreleri Grup 1 ve Grup 2 için sırasıyla 81,6 ± 64,8 ve 16,8 ± 17,4 aydı (p = 0,001). Ortalama soğuk iskemi süresi Grup 1›de Grup 2›den anlamlı olarak daha uzundu (p = 0,001). Grup 1 ve Grup 2 için operatif ortalama idrar çıkışı sırasıyla 87.3 ± 149.6 ve 634.2 ± 534.5 idi (p = 0.002). Her iki grup ortalama arter basıncı, kalp hızı, periferik oksijen satürasyonu ve CVP değerleri açısından benzerdi.

Sonuç: Canlı donör nakline göre kadavra donör nakillerinde soğuk iskemi süresi daha uzundur ve operatif idrar hacmi daha düşüktür. İyi bir preoperatif hazırlık, yakın intraoperatif takip ve uygun sıvı yönetimi ile her iki tip donör alıcıda da benzer intraoperatif hemodinamik parametreler elde edilir.

Keywords

• Anestezi
• böbrek transplantasyonu
• canlı vericiler
• hemodinamik takip
• kadavra

Comparison of intraoperative hemodynamic parameters of recipients in adult living donor and deceased donor kidney transplantations

Abstract

Objective: There are many studies on kidney transplant anesthesia, there is not enough data in the literature in terms of intraoperative parameters according to the donor type. In this study, we aimed to compare the intraoperative hemodynamic parameters in adult patients who underwent living-donor and deceased-donor kidney transplantation (KT).

Material and Methods: The patients who underwent KT were divided into 2 groups according to the donor kidney type. Recipients who underwent deceased donor transplantation were included in the study as Group 1. Among the living donor kidney transplant recipients, the same number of patients with similar demographic data as Group 1 were designated as Group 2. Both groups were compared in terms of recorded data and intraoperative hemodynamic parameters.

Results: Twenty-four patients were included in the study. The mean durations of dialysis were 81.6 ± 64.8 and 16.8 ± 17.4 months for Group 1 and Group 2, respectively (p = 0.001). The mean cold ischemia time was significantly longer in Group 1 than Group 2 (p = 0.001). The mean operative urine output for Group 1 and Group 2 were 87.3 ± 149.6 and 634.2 ± 534.5, respectively (p = 0.002). Mean arterial pressure, heart rate, peripheral oxygen saturation and CVP values were all comparable between the two groups.

Conclusion: Cold ischemia time is longer and operative urine volume is lower in deceased donor transplants compared to living donor transplants. With good preoperative preparation, close intraoperative follow-up, and proper fluid management, similar intraoperative hemodynamic parameters are achieved in both types of donor recipients.

Keywords

• Anesthesia
• cadaver
• hemodynamic monitoring
• kidney transplantation
• living donors

References

1. Aulakh NK, Garg K, Bose A, et al. Influence of hemodynamics and intra-operative hydration on biochemical outcome of renal transplant recipients. J Anaesthesiol Clin Pharmacol 2015;31:174-9.
2. Kim SJ, Lee HH, Lee DS, et al. Prognostic factors affecting graft and patient survival in cadaveric and living kidney transplantation. Transplant Proc 2004;36:2038-9.
3. Kohei N, Sawada Y, Hirai T, et al. Influence of dialysis duration on the outcome of living kidney transplantation. Ther Apher Dial 2014;18:481-8.
4. Kimura T, Ishikawa N, Fujiwara T, et al. Kidney transplantation in patients with long-term (more than 15 years) prior dialysis therapy. Transplant Proc 2012;44:75-6.
5. Prezelin-Reydit M, Combe C, Harambat J, et al. Prolonged dialysis duration is associated with graft failure and mortality after kidney transplantation: results from the French transplant database. Nephrol Dial Transplant 2019;34:538-45.
6. Kessler M, Ladriere M, Giral M, et al. Does pre-emptive kidney transplantation with a deceased donor improve outcomes? Results from a French transplant network. Transpl Int 2011;24:266-75.
7. Pérez-Flores I, Sánchez-Fructuoso A, Calvo N, et al. Preemptive kidney transplant from deceased donors: an advantage in relation to reduced waiting list. Transplant Proc 2007;39:2123-4.
8. Hirata ES, Baghin MF, Pereira RI, Alves Filho G, Udelsmann A. Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study. Rev Bras Anestesiol 2009;59:166-76.

9. Serrano OK, Vock DM, Chinnakotla S, et al. The Relationships Between Cold Ischemia Time, Kidney Transplant Length of Stay, and Transplant-related Costs. Transplantation 2019;103:401-11.
10. Gallego Valcarce E, Ortega Cerrato A, Llamas Fuentes F, et al. Short cold ischaemia time optimises transplant results for kidneys from expanded criteria donors. Nefrologia 2009;29:456-63.
11. Baxi V, Jain A, Dasgupta D. Anaesthesia for renal transplantation: an update. Indian J Anaesth 2009;53:139-47.
12. Dawidson I, Ar'Rajab A, Dickerman R, et al. Perioperative albumin and verapamil improve early outcome after cadaver renal transplantation. Transplant Proc 1994;26:3100-1.
13. Ricaurte L, Vargas J, Lozano E, Díaz L; Organ Transplant Group. Anesthesia and kidney transplantation. Transplant Proc 2013;45:1386-91.
14. Sprung J, Kapural L, Bourke DL, O'Hara JF Jr. Anesthesia for kidney transplant surgery. Anesthesiol Clin North Am 2000;18:919-51.