• nephrology
• risk factors

• Humans
• Kidney Transplantation/adverse effects
• Middle Aged
• Male
• Female
• Adult
• Central Venous Pressure
• Retrospective Studies
• Delayed Graft Function/epidemiology
• Risk Factors
• Tissue Donors
• Graft Survival
• Monitoring, Intraoperative/methods
• Transplant Recipients

• Hemodynamics
• Kidney transplantation
• Operating room
• Tidal volume

• DIA‐MS
• acute rejection
• biomarker
• diagnosis
• kidney transplantation

• Humans
• Kidney Transplantation/adverse effects
• Graft Rejection/blood
• Graft Rejection/diagnosis
• Biomarkers/blood
• Proteomics/methods
• Male
• Female
• Adult
• Middle Aged
• Mass Spectrometry
• Acute Disease
• Serum Amyloid A Protein/metabolism
• Serum Amyloid A Protein/analysis

• KJ20009 2020 Tianjin Health Science and Technology Project, Science and Technology Talent Cultivation Project
• TJYXZDXK-015A Tianjin Key Medical Discipline (Specialty) Construction Project
• 21ZXJBSY00040 Tianjin Key Science and Technology Project of Tianjin Science and Technology Bureau

• Delayed graft function
• Fluid strategies
• Kidney transplantation
• meta-analysis

• Humans
• Kidney Transplantation
• Delayed Graft Function
• Fluid Therapy

• cardiovascular disease
• kidney transplantation
• screening

• acute kidney injury
• cold ischemia time
• deceased donor
• donor age
• graft survival
• kidney transplantation
• marginal donor
• patient survival

• Adult
• Humans
• Kidney Transplantation/adverse effects
• Retrospective Studies
• Living Donors
• Delayed Graft Function/etiology
• Graft Survival
• Allografts
• Transplant Recipients

It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy, and previous reports of related cases are rare. We introduce anesthesia for Extracorporeal membrane oxygenation (ECMO)-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung.

The patient underwent comprehensive treatment for synovial sarcoma of the right lung and nodules in the lower lobe of the left lung. Examination showed pulmonary function that had severe restrictive ventilation disorder, forced expiratory volume in 1 second of 0.72 L (27.8%), forced vital capacity of 1.0 L (33%), and maximal voluntary ventilation of 33.9 L (35.5%). Lung computed tomography showed a nodular shadow in the lower lobe of the left lung, and lung metastasis was considered. After multidisciplinary consultation and adequate preoperative preparation, thoracoscopic left lower lung lobe S9bii+S10bii combined subsegmental resection was performed with the assistance of total intravenous anesthesia and ECMO intraoperative pulmonary protective ventilation. The patient received postoperative ICU supportive care. After surgical treatment, the patient was successfully withdrawn from ECMO on postoperative Day 1. The tracheal tube was removed on postoperative Day 4, and she was discharged from the hospital on postoperative Day 15.

The multi-disciplinary treatment provided maximum medical optimization for surgical anesthesia and veno-venous ECMO which provided adequate protection for the patient's perioperative treatment.

• Left single lung
• Subpulmonary segmental resection
• Extracorporeal membrane oxygenation
• Thoracoscopic
• Anesthesia
• Case report

• anaesthesia
• cardiac output
• enhanced recovery
• goal-directed therapy
• kidney transplant
• perioperative care
• renal transplant

• graft outcome
• hemodynamic monitoring
• mean arterial pressure
• patient outcome
• simultaneous pancreas–kidney transplantation

Multiple factors influence graft rejection after kidney transplantation. Pre-operative factors affecting graft function and survival include donor and recipient characteristics such as age, gender, race, and immunologic compatibility. In addition, several peri- and post-operative parameters affect graft function and rejection, such as cold and warm ischemia times, and post-operative immunosuppressive treatment. Exposure to non-self-human leucocyte antigens (HLAs) prior to transplantation up-regulates the recipient’s immune system. A higher rate of acute rejection is observed in transplant recipients with a history of pregnancies or significant exposure to blood products because these patients have higher panel reactive antibody (PRA) levels. Identifying these risk factors will help physicians to reduce the risk of allograft rejection, thereby promoting graft survival. In the current review, we summarize the existing literature on donor- and recipient-related risk factors of graft rejection and graft loss following kidney transplantation.

Cardiac index (CI; cardiac output indexed to body surface area) is routinely measured during kidney transplant surgery. Bioimpedance cardiometry is a transthoracic impedance as the non-invasive alternative for hemodynamic monitoring, using semi-invasive uncalibrated pulse wave or contour (UPC) analysis.

We performed a cross-sectional observational study on 50 kidney transplant patients to compare the CI measurement agreement, concordance rate, and trending ability between bioimpedance and UPC analysis.

For each patient, CI was measured by bioimpedance analysis (ICON^TM) and UPC analysis (EV1000^TM) devices at three time points: after induction, during incision, and at reperfusion. The device measurement accuracy was assessed by the bias value, limit of agreement (LoA), and percentage error (PE) using Bland-Altman analyses. Trending ability was assessed by angular bias and polar concordance through four-quadrant and polar plot analyses.

From each time point and pooled measurement, the correlation coefficients were 0.267, 0.327, 0.321, and 0.348. Bland-Altman analyses showed mean bias values of 1.18, 1.06, 1.48, and 1.30, LoA of -1.35 to 3.72, -1.39 to 3.51, -1.07 to 4.04, and -1.17 to 3.78, and PE of 82.21, 78.50, 68.74, and 74.58%, respectively. Polar plot analyses revealed angular bias values of -10.37º, -15.01º, -18.68º, and -12.62º, with radial LoA of 89.79º, 85.86º, 83.38º, and 87.82º, respectively. The four-quadrant plot concordance rates were 70.77, 67.35, 65.90, and 69.79%. These analyses showed poor agreement, weak concordance, and low trending ability of bioimpedance cardiometry to UPC analysis.

Bioimpedance and UPC analysis for CI measurements were not interchangeable in patients undergoing kidney transplant surgery. Cardiac index monitoring using bioimpedance cardiometry during kidney transplantation should be interpreted cautiously because it showed poor reliability due to low accuracy, precision, and trending ability for CI measurement.

Abdominal wall complications are common after kidney transplantation, and although they have a minor impact on patient and graft survival, they increase the patient's morbidity and may have an impact on quality of life. Abdominal wall complications have an overall incidence of 7.7–21%.

This review will explore the natural history of abdominal wall complications in the kidney transplant setting, with a special focus on wound dehiscence and incisional herni, with a particular emphasis on risk factors, clinical characteristics, and treatment.

Many patient‐related risk factors have been suggested, including older age, obesity, and smoking, but kidney transplant recipients have an additional risk related to the use of immunosuppression. Wound dehiscence usually does not require surgical intervention. However, for deep dehiscence involving the fascial layer with concomitant infection, surgical treatment and/or negative pressure wound therapy may be required.

Incisional hernia (IH) may affect 1.1–18% of kidney transplant recipients. Most patients require surgical treatment, either open or laparoscopic. Mesh repair is considered the gold standard for the treatment of IH, since it is associated with a low rate of postoperative complications and an acceptable rate of recurrence. Biologic mesh could be an attractive alternative in patients with graft exposition or infection.

• Incisional hernia
• biological mesh
• component separation
• dehiscence
• immunosuppression
• infection
• kidney transplantation
• laparoscopic
• mesh
• negative pressure wound therapy
• open
• pancreas
• paratransplant hernia
• primary suture
• transplantation
• wound

Optimal intra-operative fluid therapy in renal transplantation (RT) is essential to ensure adequate graft function while preventing fluid overload related complications. This RCT was to compare the intraoperative goal directed fluid therapy (GDFT) based either on corrected flow time (CFT), measured by trans oesophageal Doppler (TED) or on the stroke volume variation (SVV), by FloTrac in patients undergoing living donor RT.

This prospective, randomised controlled trial (RCT) was done on 60 end stage renal disease (ESRD) patients, American Society of Anaesthesiologists(ASA) grade III–IV, age 18 to 65 years of either sex, scheduled for living donor RT under general anaesthesia. They were randomly divided into two groups: TED group (n = 30) and FloTrac™ group (n = 30) and administered GDFT, based upon CFT (TED) and SVV (FloTrac™). The primary outcome was to compare the total fluid and number of fluid boluses administered intraoperatively, while the secondary outcomes were to compare any postoperative complications due to fluid overload and allograft function, assessed by serial serum creatinine levels up to 90 days postoperatively.

The mean total intra-operative fluid [3991.67 ± 856.32 vs. 3543.33 ± 1131.35, P = 0.089] and the amount of fluid administered per kg body weight per hour [13.32 ± 4.67 vs. 11.82 ± 4.76, P = 0.222] were lesser in the FloTrac compared to TED group, though not statistically significant. However, the postoperative incidence of allograft dysfunction, including rejection (P = 0.743) and acute tubular necrosis (ATN) (P = 0.999), and other complications (P = 0.643) were comparable.

Both TED and FloTrac devices can be used effectively to guide GDFT in RT, However, lesser total fluid was required in the FloTrac group, which may lead to a lesser number of fluid-related postoperative complications.

• Corrected flow time
• FloTrac™
• goal directed fluid therapy
• living donor renal transplantation
• stroke volume variation
• transoesophageal Doppler

• Creatinina
• Creatinine
• Fluid therapy
• Fluidoterapia
• Kidney transplantation
• Transplante renal
• Urea
• Ureia
• Urina
• Urine

• brain death
• deceased donor
• end-stage renal disease
• heme-oxygenase
• ischemia-reperfusion injury
• kidney transplantation
• living donor
• organ transplantation

• Heme Oxygenase (Decyclizing)/genetics
• Heme Oxygenase (Decyclizing)/metabolism
• Humans
• Kidney Failure, Chronic/metabolism
• Kidney Failure, Chronic/therapy
• Kidney Transplantation

Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study.

We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the “PPV” group received fluids whenever PPV was higher than 12%, patients in the “free fluid” group received fluids following our institutional standard care protocol for kidney transplantations (10 mL.kg^-1. h^-1).

Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge.

PPV guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.

• anesthesiology
• intestine
• kidney
• liver
• pancreas
• review
• transplantation

Insufficient fluid administration intra- and postoperatively may lead to delayed renal graft function (DGF), while fluid overload increases the risk of heart failure, infection, and obstipation. Several different fluid protocols have been suggested to ensure optimal fluid state. However, there is a lack of evidence of the clinical impact of these regimens. This study aimed to determine whether individualized goal-directed fluid therapy (IGDT) positively affects the initial renal function compared to a high-volume fluid therapy (HVFT) and to examine the effects on renal endothelial glycocalyx, inflammatory and oxidative stress markers, and medullary tissue oxygenation. The hypothesis was that IGDT improves early glomerular filtration rate (GFR) in pigs subjected to renal transplantation.

This was an experimental randomized study. Using a porcine renal transplantation model, animals were randomly assigned to receive IGDT or HVFT during and until 1 hour after transplantation from brain-dead donors. The kidneys were exposed to 18 hours of cold ischemia. The recipients were observed until 10 hours after reperfusion, which included GFR measured as clearance of chrom-51-ethylendiamintetraacetat (⁵¹Cr-EDTA), animal weight, and renal tissue oxygenation by fiber optic probes. The renal expression of inflammatory and oxidative stress markers as well as glomerular endothelial glycocalyx were analyzed in the graft using polymerase chain reaction (PCR) technique and immunofluorescence.

Twenty-eight recipient pigs were included for analysis. We found no evidence that IGDT improved early GFR compared to HVFT (P = .45), while animal weight increased more in the HVFT group (a mean difference of 3.4 kg [1.96–4.90]; P < .0001). A better, however nonsignificant, preservation of glomerular glycocalyx (P = .098) and significantly lower levels of the inflammatory marker cyclooxygenase 2 (COX-2) was observed in the IGDT group when compared to HVFT. COX-2 was 1.94 (1.50–2.39; P = .012) times greater in the HVFT group when compared to the IGDT group. No differences were observed in outer medullary tissue oxygenation or oxidative stress markers.

IGDT did not improve early GFR; however, it may reduce tissue inflammation and could possibly lead to preservation of the glycocalyx compared to HVFT.

Background: In 2016 we observed a marked increase in functional delayed graft function (fDGF) in our living donor kidney transplantation (LDKT) recipients from 8.5% in 2014 and 8.8% in 2015 to 23.0% in 2016. This increase coincided with the introduction of a goal-directed fluid therapy (GDFT) protocol in our kidney transplant recipients. Hereupon, we changed our intraoperative fluid regimen to a fixed amount of 50 mL/kg body weight (BW) and questioned whether the intraoperative fluid regimen was related to this increase in fDGF. Methods: a retrospective cohort analysis of all donors and recipients in our LDKT program between January 2014–February 2017 (n = 275 pairs). Results: Univariate analysis detected various risk factors for fDGF. Dialysis dependent recipients were more likely to develop fDGF compared to pre-emptively transplanted patients (p < 0.001). Recipients developing fDGF received less intraoperative fluid (36 (25.9–50.0) mL/kg BW vs. 47 (37.3–55.6) mL/kg BW (p = 0.007)). The GDFT protocol resulted in a reduction of intraoperative fluid administration on average by 850 mL in total volume and 21% in mL/kg BW compared to our old protocol (p < 0.001). In the unadjusted analysis, a higher intraoperative fluid volume in mL/kg BW was associated with a lower risk for the developing fDGF (OR 0.967, CI (0.941–0.993)). After adjustment for the confounders, prior dialysis and the use of intraoperative noradrenaline, the relationship of fDGF with fluid volume was still apparent (OR 0.970, CI (0.943–0.998)). Conclusion: Implementation of a GDFT protocol led to reduced intraoperative fluid administration in the LDKT recipients. This intraoperative fluid restriction was associated with the development of fDGF.

• delayed graft function
• fluid management
• goal-directed fluid therapy
• kidney transplantation