scholarly journals Surgical approach for kidney transplantation under spinal anesthesia

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Atta Nawabi ◽  
Peter Sullivan ◽  
Martin De Ruyter ◽  
Amy Pichoff ◽  
Clay D King ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Spinal Anesthesia ◽  
Deceased Donor ◽  
Annual Data ◽  
Short Supply ◽  
Deceased Donor Kidney ◽  
Airway Equipment ◽  
Deceased Donor Kidney Transplant ◽  
Stage Renal Disease ◽  
End Stage

Abstract Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD). It has been shown to improve quality of life as well as extending life of patients with ESRD as compared to renal replacement therapy (5-year survival rate of 68% after transplant vs 36% dialysis) (Hart A, Smith JM, Skeans MA. OPTN/SRTR 2015 annual data report: kidney. Am J Transplant 2017;17:21–116). Traditionally, patients undergo general endotracheal tube anesthesia for this surgery. During the COVID-19 pandemic, general anesthesia drugs and airway equipment were in short supply. Additionally, airway manipulation was avoided when possible due to concern for virus spread from aerosolizing procedures (i.e. intubation/extubation). In this case report, we review a 65-year-old female with an ESRD due to hypertension and diabetes that underwent deceased donor kidney transplant under spinal anesthesia. We will further discuss the benefits of spinal anesthesia in renal transplant operations.

scholarly journals Ureteric Trauma following Stent Removal in Kidney Transplant Recipient: A Unique Case of Prolonged Morbidity

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ahmad Mirza ◽  
Imran Gani ◽  
Andy Shi Huang ◽  
Ravi Mallavarapu ◽  
Laura Mulloy ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Deceased Donor ◽  
Filling Defect ◽  
Percutaneous Nephrostomy ◽  
Distal Ureter ◽  
Noncontrast Ct ◽  
Deceased Donor Kidney Transplant ◽  
Stage Renal Disease ◽  
End Stage

A 52-year-old African-American male patient with end-stage renal disease due to hypertension underwent deceased donor kidney transplant procedure with no immediate complications. The postprocedure complications, interventions, and course were abstracted by chart review. The ureteric stent was removed with flexible cystoscopy on postoperative day (POD) 24. 24 hours later, the patient presented with abdominal pain and inability to urinate. An urgent ultrasound and noncontrast CT scan showed grade 4 hydronephrosis of the transplanted kidney. A percutaneous nephrostomy stent was placed for urinary diversion. A large ureteric hematoma filling the lumen of the mid to distal ureter was identified on the nephrostogram and was evacuated. A follow-up nephrostogram on POD 44 revealed a distal ureter stricture and persistent well-formed midureter filling defect. A repeat nephrostogram performed at POD 72 was done with stricture dilatation, internalization of stents, and removal of a percutaneous nephrostomy tube. The patient was maintained on antibiotics for UTI prophylaxis throughout the course.

scholarly journals Short Bowel Syndrome and Kidney Transplantation: Challenges, Outcomes, and the Use of Teduglutide

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Elizabeth Abou Diwan ◽  
Ankit B. Patel ◽  
Alex G. Cuenca ◽  
Nahel Elias ◽  
Hannah M. Gilligan ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Short Bowel Syndrome ◽  
Kidney Transplant Recipient ◽  
Deceased Donor ◽  
Volume Depletion ◽  
Short Bowel ◽  
Deceased Donor Kidney ◽  
Deceased Donor Kidney Transplant ◽  
First Time

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn’s disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient.

scholarly journals Kidney transplantation in Kazakhstan: the burden of organ shortage

2021 ◽  
Vol 23 (2) ◽  
pp. 36-40
Author(s):  
S. A. Abdugafarov ◽  
M. N. Assykbayev ◽  
D. J. Saparbay
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
Survival Rates ◽  
Graft Function ◽  
Deceased Donor ◽  
Organ Shortage ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
End Stage

Kidney transplantation has been the best replacement therapy for end-stage kidney disease for over 60 years. The Republican Coordination Center for Transplantation reports that as of January 29, 2020, there were 2675 people on the kidney transplant waiting list in the Republic of Kazakhstan. The issue of deceased donation in Kazakhstan is problematic for various reasons. Over the past couple of years, the already low rates of deceased donors have fallen by more than 2 times.Objective: to objectively assess the effectiveness of deceased-donor kidney transplant in order to indicate the need for development of cadaveric donation and reduce the number of patients in the transplant waitlist.Materials and methods. Fifty-two kidney transplants from a deceased donor were performed at the National Research Oncology Center (NROC) from 2010 to 2020. The age group of recipients ranged from 20 to 75 years old. In most cases, end-stage chronic renal failure resulted in chronic glomerulonephritis (76%), pyelonephritis (1.9%), polycystic kidney disease (9.6%) and diabetic nephropathy (11.5%).Results. The 1-year and 5-year survival rates were 96% and 86%, respectively. There was delayed graft function in 13 of cases. In one case (1.92%), there was intraoperative hyperacute rejection of the kidney transplant that could not be treated with high doses of glucocorticosteroids; the kidney graft was removed. Two patients (3.8%) in the early postoperative period, on days 2 and 7 after surgery, developed a clinic of acute renal transplant rejection; after the rejection crisis was stopped by drug therapy, graft function was restored. One patient (1.92%) died as a result of bilateral pneumonia, which led to sepsis and death.Conclusion. Graft and recipient survival rates after deceased-donor kidney are comparable to those after living-donor kidney transplantation. The solution to the problems of increasing the number of deceased organ transplants should not rest entirely on the shoulders of transplant doctors; this task must also be addressed at the government level with constant propaganda to explain to the citizens the need for a deceased organ donation program.

P1728FUROSEMIDE STRESS TEST PREDICTS DISCHARGE SERUM CREATININE AFTER KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Armando Coca ◽  
Guadalupe Tabernero ◽  
Carlos Arias-Cabrales ◽  
Jimmy Reinaldo Sanchez Gil ◽  
Jose Antonio Menacho Miguel ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Stress Test ◽  
Graft Function ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Deceased Donor Kidney Transplant

Abstract Background and Aims Acute tubular necrosis is a common complication after kidney transplantation and is closely related to delayed graft function (DGF) and slower graft function recovery after surgery. The furosemide stress test (FST) uses a standardized dose of furosemide to evaluate the integrity of the renal tubule and determine which patients have developed severe tubular damage. We aimed to apply the FST to a sample of incident deceased-donor kidney transplant recipients and describe its association with DGF and serum creatinine (SCr) at discharge. Method Single-center prospective observational study of deceased-donor kidney transplant recipients. The FST, a standardized bolus dose of furosemide (1.5 mg/kg) was administered between the 3rd and 5th day after surgery. Patients were excluded if, during that time period, they presented evidence of active bleeding, obstructive uropathy or volume depletion. Urine output (UO) 60 and 120 min after FST was registered. To reduce the risk of hypovolemia, each ml of UO produced for six hours after FST was replaced with 1 ml of normal saline. Results 25 patients were included in the study. Mean 2h FST UO was 1012±570 ml. Demographic and clinical data are summarized in Table 1. Subjects that suffered DGF had a significantly lower 2h FST UO (534 vs 1164 ml; P=0.015). In adjusted linear regression analysis only a 2h FST UO<1000 ml (β=0.906; 95%CI: 0.04-1.772; P=0.041) and DGF (β=1.592; 95%CI: 0.488-2.696; P=0.008) were independent predictors of SCr at discharge (model adjusted for recipient age, cold ischemia time, number of HLA mismatches, donor SCr and donor hypertension). Conclusion Recipients with a 2h FST UO <1000 ml suffered DGF more frequently. FST and DGF were independent predictors of SCr at discharge. A standardized FST could help clinicians distinguish patients with more severe tubular dysfunction and higher risk of DGF.

scholarly journals A Case of Alport Syndrome with Posttransplant Antiglomerular Basement Membrane Disease despite Negative Antiglomerular Basement Membrane Antibodies by EIA Treated with Plasmapheresis and Intravenous Immunoglobulin

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Sumiko I. Armstead ◽  
Thomas Hellmark ◽  
Jorgen Wieslander ◽  
Xin J. Zhou ◽  
Ramesh Saxena ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Intravenous Immunoglobulin ◽  
Alport Syndrome ◽  
Kidney Injury ◽  
Deceased Donor ◽  
End Of Treatment ◽  
Circulating Antibodies ◽  
Deceased Donor Kidney Transplant ◽  
Stage Renal Disease ◽  
End Stage

Posttransplant antiglomerular basement membrane (anti-GBM) disease occurs in approximately 5% of Alport patients and usually ends in irreversible graft failure. Recent research has focused on characterizing the structure of the anti-GBM alloepitope. Here we present a case of a 22-year-old male with end-stage renal disease secondary to Alport syndrome, with a previously failed renal allograft, who received a second deceased-donor kidney transplant. Six days after transplantation, he developed acute kidney injury. The serum anti-GBM IgG was negative by enzyme immunoassay (EIA). On biopsy, he had crescentic glomerulonephritis with linear GBM fixation of IgG. With further analysis by western blotting, we were able to detect antibodies to an unidentified protein from the basement membrane. This patient was treated with plasmapheresis twice per week and monthly intravenous immunoglobulin (IVIG) for a total of five months. At the end of treatment, these unknown antibodies were no longer detected. His renal function improved, and he has not required dialysis. We conclude that anti-GBM disease in patients with Alport Syndrome may be caused by circulating antibodies to other components of the basement membrane that are undetectable by routine anti-GBM EIA and may respond to treatment with plasmapheresis and IVIG.

scholarly journals Identifying Needs and Barriers to Engage Family Members in Transplant Candidate Care

2021 ◽  
pp. 152692482110027
Author(s):  
Warren T. McKinney ◽  
Marilyn J. Bruin ◽  
Sophie Kurschner ◽  
Melissa R. Partin ◽  
Allyson Hart
Keyword(s):  
Kidney Transplantation ◽  
Family Members ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
The Family ◽  
Multiple Challenges ◽  
Transplant Candidates ◽  
End Stage ◽  
Improve Patient

Introduction: Friends and family members provide critical support to patients on the waitlist for deceased donor kidney transplantation. However, little is known about how best to support and engage them effectively to improve patient outcomes. Methods: We conducted 5 focus groups with the family members of patients on the waitlist for a deceased donor kidney (n=23) to identify individual- and group-level targets for an intervention. Discussions encouraged participants to reflect on their support roles, experiences at the transplant evaluation, interactions with providers, knowledge of transplant options and expected outcomes. Transcripts of study sessions were coded using an iterative and inductive process. Results: The thematic analysis produced two main themes related to experiences providing care to patients on the waitlist for kidney transplantation. First, participants revealed that supporting a patient on the waitlist created challenges that reverberate through their entire social structure. Family members discussed frustrations with adapting to their patient’s kidney health needs, feelings of isolation, and barriers to identifying and building effective support networks. Second, participants described multiple challenges that prevented their patient-family unit from making informed decisions about transplant care. These challenges included communication with their patient, patients resisting help, difficulty understanding the information, and feeling helpless. Conclusion: Family members providing care to patients with end-stage kidney disease require targeted support to overcome the unique challenges associated with their role in helping to meet their patient’s clinical needs. Interventions to engage friends and family members in the care of kidney transplant candidates need to effectively address these challenges.

scholarly journals Successful Transplantation of a Split Crossed Fused Ectopic Kidney into a Patient with End-Stage Renal Disease

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Kristin L. Mekeel ◽  
Shane M. Daley ◽  
Paul E. Andrews ◽  
Adyr A. Moss ◽  
R. L. Heilman ◽  
...  
Keyword(s):  
Deceased Donor ◽  
Technical Difficulty ◽  
Parenchymal Transection ◽  
Ectopic Kidney ◽  
Renal Anomalies ◽  
Successful Transplantation ◽  
Immediate Function ◽  
Deceased Donor Kidney Transplant ◽  
Stage Renal Disease ◽  
End Stage

Potential donors with congenital renal anomalies but normal renal function are often overlooked because of a possible increase in technical difficulty and complications associated with the surgery. However, as the waiting list for a deceased donor kidney transplant continues to grow, it is important to consider these kidneys for potential transplant. This paper describes the procurement of a crossed fused ectopic kidney, and subsequent parenchymal transection prior to transplantation as part of a combined simultaneous kidney pancreas transplant. The transplant was uncomplicated, and the graft had immediate function. The patient is now two years from transplant with excellent function.

scholarly journals Evaluation of the Recipient and Donor in Living Kidney Transplantation

2020 ◽  
Vol 95 (4) ◽  
pp. 260-265
Author(s):  
Ha Yeol Park ◽  
Byung Chul Shin
Keyword(s):  
Kidney Transplantation ◽  
Supply And Demand ◽  
Deceased Donor ◽  
Good Health ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Kidney transplantation is the treatment of choice for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk of patients, as compared to maintenance dialysis. The number of patients awaiting kidney transplantation has steadily increased, and the gap between allograft supply and demand continues to widen despite initiatives to expand the use of nonstandard deceased-donor allografts. The use of organs from living donors is one strategy to address the need for transplants. A medical, surgical, and psychosocial evaluation is mandatory prior to living kidney donation to ensure that the donor candidate is in good health and has normal kidney function, is not a risk to the recipient with respect to transmission of infections and malignancy, and will not face unacceptable risks after donation.

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