Search

Opioid exposure is a concern after live donation for kidney transplant. We theorized that an enhanced recovery after surgery pathway (ERAS) using pregabalin preoperatively to desensitize nerves followed by the nonsteroidal anti-inflammatory drug ketorolac, during and after surgery, can control pain, thus requiring less perioperative narcotics. The aim of this study was to determine if the use of a nonopioid analgesic ERAS protocol for donor nephrectomies could decrease the use of narcotics without an increase in complications compared with standard of care (SOC). This is a single-center, prospective, double-blind, randomized clinical trial involving a total of 62 patients undergoing nephrectomy for live donor kidney transplant. Length of hospital stay (LOS) was significantly reduced by 10% in the ERAS group versus the SOC-plus-placebo group. Morphine dose equivalents were significantly reduced by 40% in the study group versus the SOC-plus-placebo group. The use of this nonopioid analgesic ERAS pathway for donor nephrectomies decreased the use of narcotics without an increase in complications compared with SOC. There was significantly reduced LOS and less narcotic use in the study group versus the SOC-plus-placebo group. (ClinicalTrials.gov registration number: NCT03669081)., (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Purpose: In patients with loin pain hematuria syndrome (LPHS), a response to percutaneous renal hilar blockade (RHB) and a multidisciplinary team (MDT) evaluation predicts patient's potential renal auto-transplantation (RAT) success., Methods: A pain assessment was performed using a 0-10 numeric pain rating scale prior to a percutaneous RHB under CT guidance. If the pain score was reduced > 50% immediately after the RHB, patients were evaluated for RAT by a MDT. Pre-operative and 1-year post-operative quality-of-life surveys were administered to each RAT patient., Results: 43 LPHS patients were referred for RHB. Of the 38 patients who received a RHB, 31 had > 50% reduction in pain scores. Pre- and post-RHB mean pain scores were 6/10 and 0.7/10, respectively, in patients who had > 50% reduction in pain. 22 of the patients who responded favorably then proceeded to RAT. Twelve patients had at least 1-year follow-up after RAT. All patients had a meaningful decrease in their pain. Mean pain score at 1 year was 0.8/10 for an 85% overall reduction in pain. 92% of patients experienced a ≥ 50% reduction in pain at 1 year. Mean Beck Depression Inventory (BDI) score (0-66) 1 year after RAT decreased from 25.2 pre-op (moderate depression) to 12.8 post-op (minimal depression)., Conclusions: A MDT approach utilizing a RHB should be considered as a tool to select appropriate LPHS patients for RAT to achieve long-term success in reducing chronic pain and depression while increasing quality of life.

Aortorenal bypass is an effective and durable therapy for autoimmune-induced renovascular hypertension. However, when technical and patient factors preclude this option, renal autotransplantation can be a viable alternative. We present a 32-year-old woman who underwent aortobi-iliac bypass with left renal autotransplantation for malignant hypertension secondary to Takayasu arteritis. This is the first description of using machine preservation with a continuous pulsatile perfusion pump to maintain renal preservation before reimplantation. Our method proved safe to the patient and allowed for protection of the organ from prolonged warm ischemia and intraoperative hypoperfusion during a complex reconstruction., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Whether peritoneal dialysis is a risk factor for the development of intra-abdominal infection (IAI) after simultaneous pancreas kidney (SPK) transplantation is controversial., Methods: We investigated the incidence of IAI, and patient and pancreas graft survival rates of 120 patients that received SPK between November 1995 and August 2003. All patients were dialysis-dependent prior to transplantation; mean duration of peritoneal dialysis (PD; n=52) and hemodialysis (HD; n=68) was 20+/-15 months and 23+/-16 months, respectively., Results: IAI developed in five PD and six HD patients (P=0.88). The time of diagnosis of IAI and the spectrum of organisms cultured were similar in the two groups of patients. Age, duration of dialysis, and method of exocrine drainage did not have a significantly impact on infection rate. Patient and pancreas graft survival rates were 92.3% and 88.4% in the PD group and 95.5% and 92% HD group (p=ns) after a mean follow-up of 42+/-27 months and 39+/-27 months, respectively. Overall patient and pancreas graft survival was not significantly affected by IAI., Conclusions: PD does not adversely affect IAI rate and is a safe mode of dialysis for patients awaiting SPK transplantation.

As the population ages, the transplant community will continue to see "elderly" patients with end-stage kidney disease who are seeking transplantation. In this report we describe long-term outcomes of 315 primary kidney transplants performed at the University of Florida in recipients aged > or = 60 years and compare them to results from 3 younger recipient cohorts. Among recipients > or = 60 years, patient survival was significantly worse than for younger recipients but no differences in graft or death-censored graft survival were seen. We suspect that although patient survival was worst in the oldest group, there were likely other causes of graft loss within the younger groups that balanced the effects of death on graft survival in the oldest group. Among recipients aged > or = 60 years, patient survival at 10 years was 55% for living-donor kidney recipients and 46% for deceased-donor kidney recipients. African-American recipients had a higher risk of mortality and graft loss in all age groups after deceased donor kidney transplantation but not after living donor transplantation. Delayed graft function negatively impacted outcomes among all recipients and the adverse effects were greater after deceased donor than living donor transplantation. These effects were also seen within the oldest recipient age group. Increased donor age was a significant risk factor for death and graft loss among all age groups after deceased donor kidney transplantation but not among living-donor kidney recipients. More specifically, recipients aged > or = 60 years who received kidneys from donors > or = 60 years demonstrated significantly worse outcomes when compared to those receiving donor kidneys < 60 years. The presence of diabetes mellitus in recipients > or = 60 years was not a significant risk factor for mortality or graft loss after transplantation. Acceptable results can be obtained after kidney transplantation in recipients aged > or = 60 years. Future investigations should focus on improving recipient selection in the elderly population, identifying strategies to minimize DGF in deceased donor kidneys, understanding all variables involved in the risk associated with recipient race, and increasing living donor transplantation across all age groups.