scholarly journals Sugammadex Compared to Neostigmine for Reversal of Neuromuscular Block in Patients Undergoing Kidney Transplantation. A Retrospective Cohort, Case-Control Study.

2021 ◽  
Author(s):  
Michele Carron ◽  
Giulio Adreatta ◽  
Elisa Pesenti ◽  
Alessandro De Cassai ◽  
Paolo Feltracco ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Neuromuscular Block ◽  
Unit Length ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit ◽  
Anaesthesia Care ◽  
Stage Renal Disease ◽  
Pacu Stay ◽  
The Impact

Abstract Background: The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation.Methods: A retrospective, observational study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anaesthetic and surgical times, post-anaesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications.Results: No significant differences in patient or, with the exception of drugs involved in NMB management, anaesthetic and surgical characteristics were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p=0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p=0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p=0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significant lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p=0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p<0.001), and reduced ICU admissions (0.6% vs 8.0%, p=0.001).Conclusions: Compared to neostigmine for reversal of NMB, sugammadex resulted in a better recovery profile in patients undergoing kidney transplantation.

Impact of smoking on kidney transplantation outcomes

2016 ◽  
Vol 88 (12) ◽  
pp. 45-50
Author(s):  
A G Stolyar ◽  
N A Tomilina
Keyword(s):  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Graft Function ◽  
Left Ventricular ◽  
Patient Status ◽  
Postoperative Hypertension ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Transplantation Outcomes

Aim. To investigate the impact of smoking on kidney transplantation outcomes. Subjects and methods. The materials of 350 patients (including 229 (65.4%) men aged 37.1±0.6 years) who had undergone kidney allotransplantation (KAT) for end-stage renal disease were analyzed. The main outcomes of KAT (patient status (alive or dead); renal allograft (RAG) function or dysfunction; development of chronic transplant nephropathy (CTN)), were studied. Results. There were 52 (14.8%) smoking patients (50 (96.2%) men and 2 (3.8%) women). The survival rate of smokers after KAT was significantly lower (p=0.043), as was the duration of graft function in the smoking patients (p=0.038). There were statistically significant associations of smoking with age, sex, time to normalize post-KAT serum creatinine concentrations, the development of CTN and graft rejection crises, postoperative hypertension, post-KAT serum creatinine, hemoglobin, and albumin levels, pretransplantation alanine aminotransferase concentrations, pre-KAT left ventricular hypertrophy, patient compliance with the prescribed treatment regimen, the presence or absence of a job in the patient after KAT (p

scholarly journals Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Carron ◽  
G. Andreatta ◽  
E. Pesenti ◽  
A. De Cassai ◽  
P. Feltracco ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Retrospective Cohort ◽  
Case Control Study ◽  
Neuromuscular Block ◽  
Case Control ◽  
Single Center ◽  
Pacu Stay ◽  
Control Study

Abstract Background The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation. Methods A single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anesthetic and surgical times, post-anesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications. Results No significant differences in patient or, with the exception of drugs involved in NMB management, anesthetic, and surgical characteristics, were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p = 0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p = 0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p = 0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significantly lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p = 0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p < 0.001), and reduced ICU admissions (0.6% vs 8.0%, p = 0.001). Conclusions Compared to cisatracurium-neostigmine, the rocuronium-sugammadex strategy for reversal of NMB showed a better recovery profile in patients undergoing kidney transplantation.

Abstract 022: Cystatin C Strengthens the Association of Kidney Function with Mortality and End-Stage Renal Disease

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Michael G Shlipak ◽  
Kunihiro Matsushita ◽  
Johan Ärnlöv ◽  
Lesley A Inker ◽  
Ronit Katz ◽  
...  
Keyword(s):  
General Population ◽  
Renal Disease ◽  
Serum Creatinine ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Diverse Populations ◽  
Net Reclassification Improvement ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Background: Adding cystatin C to serum creatinine improves accuracy of estimated glomerular filtration rate (eGFR), but the impact on detection, staging and prognosis of chronic kidney disease (CKD) across diverse populations has not been determined. Methods: Meta-analyses including 11 general population cohorts (N=90,750 participants) and 5 CKD cohorts (N=2,960) with standardized serum creatinine and cystatin C at baseline. We compared associations of baseline GFR estimated by CKD-EPI equations using creatinine (eGFR cr ) vs. cystatin C (eGFR cys ) with mortality (13,202 deaths from 15 cohorts) and incident end-stage renal disease (ESRD) (1,654 cases from 7 cohorts) during mean follow-up of 7.7 years and studied prognostic consequences of reclassification. Results: In the general population cohorts, mean eGFRs were 85 ml/min/1.73m 2 for both equations but prevalence of eGFR<60 ml/min/1.73m 2 was higher for eGFR cys vs. eGFR cr (13.7% vs. 9.7% [12,403 vs. 8,833 of 90,750]). Across all eGFR cr categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m 2 ), upward and downward reclassification by eGFR cys was associated with lower and higher risk, respectively; net reclassification improvement for eGFR cys compared with eGFR cr was 0.23 (0.18-0.28) for mortality and 0.10 (0.00-0.21) for ESRD. Among participants with eGFR cr 45-59 ml/min/1.73m 2 (N=6,358), ~40% were reclassified to higher eGFR cys categories and had lower risks of mortality (adjusted hazard ratio 0.66; 95% CI 0.57-0.77) and ESRD (0.20; 0.08-0.53) compared to those who were not reclassified. Among participants with eGFR cr 60-89 ml/min/1.73m 2 (N=43,630), ~13% were reclassified to lower eGFR cys categories and had higher risk for mortality (1.57; 1.39-1.78) and ESRD (2.66; 1.52-4.67) compared to no reclassification. The results for CKD cohorts were largely similar. Conclusions: Cystatin C strengthens the association of eGFR with risk across diverse populations providing a potentially useful adjunct to eGFR cr for detection and staging of CKD.

scholarly journals The Impact of Histologic Variants on FSGS Outcomes

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kristin Meliambro ◽  
Monica Schwartzman ◽  
Paolo Cravedi ◽  
Kirk N. Campbell
Keyword(s):  
Kidney Transplantation ◽  
End Stage Renal Disease ◽  
Clinical Course ◽  
Steroid Resistance ◽  
Favorable Prognosis ◽  
Interpretation Errors ◽  
Risk Of Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Focal segmental glomerulosclerosis (FSGS) is the most common glomerular disease leading to end-stage renal disease. The clinical course is highly variable with disparate responses to therapeutic intervention and rates of progression. Histologic variant subtype has been commonly used as a prognostic and therapeutic guide in the clinical management of FSGS. The tip lesion is widely considered to portend the most favorable prognosis and to be the most responsive to steroid therapy. Conversely, the collapsing lesion, more prevalent in patients of African descent, is associated with steroid resistance and higher risk of disease progression. In the 10 years since the Columbia classification system for FSGS was published, some retrospective and one prospective study explored the impact of histologic variants at the time of biopsy on FSGS outcomes. The results largely validate its clinical predictive value with respect to treatment response, though its utility in cases recurring after kidney transplantation is still unknown. Sampling and interpretation errors are additional sources of caution. More research is needed to fully define reproducible prognostic and therapeutic markers for this polymorphic disorder.

scholarly journals Adipose-Derived Stem/Stromal Cells in Kidney Transplantation: Status Quo and Future Perspectives

2021 ◽  
Vol 22 (20) ◽  
pp. 11188
Author(s):  
Gabriele Storti ◽  
Evaldo Favi ◽  
Francesca Albanesi ◽  
Bong-Sung Kim ◽  
Valerio Cervelli
Keyword(s):  
Kidney Transplantation ◽  
Stromal Cells ◽  
Ischemia Reperfusion Injury ◽  
Current Knowledge ◽  
Ischemia Reperfusion ◽  
Graft Function ◽  
Future Perspective ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Kidney transplantation (KT) is the gold standard treatment of end-stage renal disease. Despite progressive advances in organ preservation, surgical technique, intensive care, and immunosuppression, long-term allograft survival has not significantly improved. Among the many peri-operative complications that can jeopardize transplant outcomes, ischemia–reperfusion injury (IRI) deserves special consideration as it is associated with delayed graft function, acute rejection, and premature transplant loss. Over the years, several strategies have been proposed to mitigate the impact of IRI and favor tolerance, with rather disappointing results. There is mounting evidence that adipose stem/stromal cells (ASCs) possess specific characteristics that could help prevent, reduce, or reverse IRI. Immunomodulating and tolerogenic properties have also been suggested, thus leading to the development of ASC-based prophylactic and therapeutic strategies in pre-clinical and clinical models of renal IRI and allograft rejection. ASCs are copious, easy to harvest, and readily expandable in culture. Furthermore, ASCs can secrete extracellular vesicles (EV) which may act as powerful mediators of tissue repair and tolerance. In the present review, we discuss the current knowledge on the mechanisms of action and therapeutic opportunities offered by ASCs and ASC-derived EVs in the KT setting. Most relevant pre-clinical and clinical studies as well as actual limitations and future perspective are highlighted.

The Impact of Postoperative Intensive Care Unit Admission on Postoperative Hospital Length of Stay and Costs

2019 ◽  
Vol 129 (3) ◽  
pp. 753-761 ◽  
Author(s):  
Tharusan Thevathasan ◽  
Curtis C. Copeland ◽  
Dustin R. Long ◽  
Maria D. Patrocínio ◽  
Sabine Friedrich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit ◽  
The Impact

scholarly journals Outcome of pulmonary hypertension in patient on dialysis following kidney transplantation: an observational study

2018 ◽  
Vol 6 (9) ◽  
pp. 2948
Author(s):  
Vasanth G. ◽  
Siva N. ◽  
Rajendran G. ◽  
Venu G.
Keyword(s):  
Pulmonary Hypertension ◽  
Kidney Transplantation ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Clinical Information ◽  
Study Population ◽  
Pulmonary Arterial ◽  
The Mean ◽  
Stage Renal Disease ◽  
The Impact

Background: Pulmonary hypertension (PH) is common among patients with end stage renal disease (ESRD) who are on dialysis and PH is associated with higher mortality rates among these patients. The impact of kidney transplantation on pulmonary hypertension is unknown. The purpose of this study is to evaluate the impact of successful kidney transplantation on pulmonary arterial hypertension in these patients on dialysis.Methods: The study was conducted on patients who underwent kidney transplantation in Department of Nephrology PSGIMSR. Patients with pulmonary hypertension pre transplant were taken up for the study after the application of inclusion and exclusion criteria and after obtaining consent. Demographic, clinical information and laboratory results were collected. The assessment of PH was done by Doppler echocardiography pre transplant and   3 and 6 months after transplant during follow up.Results: The prevalence of PH was 40%. The mean age of study population was 42 ± 8.7 years. The mean dialysis duration of study population was 32±8 months. 54.5% were male. 45.5% were female. Out of the 55 transplant recipients, 22 patients had elevated PASP on preoperative echocardiography examination.  Compared to pre-transplant values, a significant decrease was observed in mean SPAP values and the severity of pulmonary hypertension 3 and6 months postoperative follow up (p<0.003).Conclusions: The prevalence of pre-operative PH among dialysis patient was high. Kidney transplantation leads to considerable improvement in pulmonary arterial hypertension in patients on dialysis.

Comparison of functional and morphological changes of transplanted kidneys from marginal and ideal donors

2012 ◽  
Vol 153 (45) ◽  
pp. 1793-1796
Author(s):  
Bernadett Borda
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Interstitial Fibrosis ◽  
Number Of Patients ◽  
Significant Difference ◽  
One Year ◽  
The Impact ◽  
Marginal Donors

Introduction: Despite an increased number of cadaver donors and organ transplantations, there is a marked increase in the number of patients included in the transplantation waiting list. Aim and method: The aim of the study was to evaluate functional and morphologic changes of kidney allografts obtained from marginal (n = 63) and “ideal” donors (n = 186). In patients with kidneys from marginal donors, the impact of donor age and the presence of hypertension in donors on kidney function were also studied. Results: One year after kidney transplantation, kidney function was similar in patients transplanted with kidneys from marginal and “ideal” donors, although significant morphologic differences were observed between the two groups. However, five years after transplantation serum creatinine (p = 0.0001) and eGFR (p = 0.003) were significantly different between patients transplanted with kidneys from marginal and “ideal” donors. There was also a significant difference in serum creatinine level of patients who received kidneys from donors older than 55 years of age compared to patients whose kidney allografts were obtained form donor who has hypertension (p = 0.0003). Acute rejection episodes (p = 0.0004) and interstitial fibrosis/tubular atrophy (p = 0.002) occurred more frequently in patients with kidneys from marginal compared to those from “ideal” donors. Conclusion: One year after kidney transplantation renal function is similar in patients transplanted with kidneys from marginal and „ideal” donors, but patients with kidneys from marginal donors have significantly more impaired renal function five years after kidney transplantation. Orv. Hetil., 2012, 153, 1793–1796.

Intraoperative haemodynamics and postoperative intensive care unit admission in older patients with cancer

2021 ◽  
pp. 175045892110123
Author(s):  
Anoushka M Afonso ◽  
Dahniel Sastow ◽  
Joshua B Cadwell ◽  
Robert J Downey ◽  
Gregory W Fischer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Older Patients ◽  
Multivariable Analysis ◽  
Hypertensive Urgency ◽  
Patients With Cancer ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit ◽  
The Impact

Purpose Research on the impact of various intraoperative haemodynamic variables on the incidence of postoperative ICU admission among older patients with cancer is limited. In this study, the relationship between intraoperative haemodynamic status and postoperative intensive care unit admission among older patients with cancer is explored. Methods Patients aged ≥75 who underwent elective oncologic surgery lasting ≥120min were analysed. Chi-squared and t-tests were used to assess the associations between intraoperative variables with postoperative intensive care unit admission. Multivariable regressions were used to analyse potential predict risk factors for postoperative intensive care unit admission. Results Out of 994 patients, 48 (4.8%) were admitted to the intensive care unit within 30 days following surgery. Intensive care unit admission was associated with the presence of ≥4 comorbid conditions, intraoperative blood loss ≥100mL, and intraoperative tachycardia and hypertensive urgency. On multivariable analysis, operation time ≥240min (Odds Ratio [OR] = 2.29, p = 0.01), and each minute spent with intraoperative hypertensive urgency (OR = 1.06, p = 0.01) or tachycardia (OR = 1.01, p = 0.002) were associated with postoperative intensive care unit admission. Conclusion Intraoperative hypertensive urgency and tachycardia were associated with postoperative intensive care unit admission in older patients undergoing cancer surgery.

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