Intraoperative Management of the Kidney Transplant Recipient

AbstractPurpose of ReviewThe purpose of this study was to review current literature on the intraoperative management of the kidney transplant recipient in terms of preoperative evaluation, anesthetic agents of choice, monitoring needs, intraoperative fluid and hemodynamic management, and perioperative pain control options.Recent FindingsMore recent literature regarding intraoperative kidney management suggests less aggressive volume loading with a balanced crystalloid solution, particularly in regard to albumin and blood products, with increased consideration for multimodal therapies for nausea and pain control.SummaryPerioperative kidney management is crucial to immediate- and long-term outcomes for graft and patient survival. Surgical and anesthetic techniques should continue to be honed to allow for ideal renal perfusion intraoperatively. Considerations for intraoperative optimization for renal transplantation include the appropriate types and volume of fluid based on cardiac risk factors with the increasing number of elderly recipients, the avoidance of vasoconstrictive agents, and a reduction in perioperative cardiac-depressing agents for pain that may be managed by multimodal therapies.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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Surgeons at the Cleveland Clinic managed to implant a donor kidney into a patient using a surgical robot, and all through one small incision. The technique, in which instruments as well as the donor kidney can be passed through a four centimeter (1.6...
Source: Medgadget - Category: Medical Devices Authors: Tags: Surgery Urology Source Type: blogs
We reported 1 patient with donor-derived CRKP infection following liver transplantation and 2 patients following renal transplantation (1 liver and 2 kidneys were from the same donor), who experienced sudden abdominal pain and abdominal hemorrhage almost at the same time after organ transplantation. Diagnosis: The patients were diagnosed as graft arteries rupture due to corrosion caused by CRKP infection based on computed tomography scan, blood culture, laparotomy, and pulse-field gel electrophoresis. Interventions: Anti-shock treatment, exploratory laparotomy, broad-spectrum antibiotics, and abdominal puncture and d...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Robert Chelsea turned down the first face he was offered. It was a fine face, one that could have taken him off the transplant waiting list after just a couple months. But Chelsea—severely disfigured after a catastrophic car accident five years earlier—was in no hurry. He’d gotten used to tilting his head back so food and water wouldn’t fall out of his nearly lipless mouth. He knew how to respond compassionately to children who stared in shock and fear. The face, offered in May 2018, had belonged to a man with skin that was much fairer than what remained of Chelsea’s—so light that Chelse...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized Healthcare Source Type: news
CONCLUSIONS: Bisphosphonate therapy may reduce fracture and bone pain after kidney transplantation, however low certainty in the evidence indicates it is possible that treatment may make little or no difference. It is uncertain whether bisphosphonate therapy or other bone treatments prevent other skeletal complications after kidney transplantation, including spinal deformity or avascular bone necrosis. The effects of bone treatment for children and adolescents after kidney transplantation are very uncertain. PMID: 31637698 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Abstract Kidney transplant is a choice option for treatment of chronic kidney failure because it is associated with cost-effective and normal quality of life. To increase the number of living kidney donors, laparoscopic and minimal invasive modalities have been introduced. Here, we present a case of a living donor with an extremely rare complication after laparoscopic donor nephrectomy that presented as massive chylous ascites. Kidney donor operation can be performed with the use of 3 modalities: traditional open, laparoscopic, and open with minimally invasive. All 3 modalities may be associated with some complica...
Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation - Category: Transplant Surgery Authors: Tags: Exp Clin Transplant Source Type: research
By SAURABH JHA, MD Despite an area under the ROC curve of 1, Cassandra’s prophesies were never believed. She neither hedged nor relied on retrospective data – her predictions, such as the Trojan war, were prospectively validated. In medicine, a new type of Cassandra has emerged –  one who speaks in probabilistic tongue, forked unevenly between the probability of being right and the possibility of being wrong. One who, by conceding that she may be categorically wrong, is technically never wrong. We call these new Minervas “predictions.” The Owl of Minerva flies above its denominator. ...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Artificial Intelligence Data Medical Practice Physicians RogueRad @roguerad acute kidney injury AI deep learning machine learning predictions Saurabh Jha Source Type: blogs
ConclusionWith increasing experience, grafts with challenging vascular anatomy can be taken up for RAKT and GMVs should not be considered as a contraindication for RAKT.
Source: International Urology and Nephrology - Category: Urology & Nephrology Source Type: research
Conditions:   Opioid Use;   Kidney Diseases;   Pain, Postoperative;   Postoperative Complications;   Postoperative Nausea and Vomiting Interventions:   Procedure: multimodal pain management;   Other: goal directed fluid management;   Other: preoperative carbohydrate loading;   Procedure: Donor nephrectomy;   Procedure: regional anesthesia Sponsor:   Thomas Jefferson University Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
ConclusionWe found multiple heterogeneous predictors for SL with a common denominator related to surgical management of the retroperitoneal space, peritoneum and the ureter. Future prospective studies are necessary to evaluate the influence of these variables on the development of SL.
Source: International Urology and Nephrology - Category: Urology & Nephrology Source Type: research
We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature. Patient concerns and diagnoses: A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and s...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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