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Ischemic and reperfusion injury (IRI) occurs during organ transplantation. IRI during liver transplantation is well studied and established; results in coagulopathy due to release of heparin-like substances and platelet trapping. During renal transplantation, similar IRI phenomenon occurs, and thromboelastography (TEG) can be used to detect and manage coagulopathy. The preoperative, immediate postreperfusion, and postoperative day 1 TEG was done on 25 cases of live-related renal transplantation. Coagulopathy was defined by deranged and abnormal TEG variables values from baseline and supported by the clinical presence of nonsurgical oozing and bleeding in the surgical field. The postreperfusion TEG values showed coagulopathic changes. About 64% of patients had R-time (RT) more than 12 min, 64% of patients showed maximum amplitude (MA) <55 mm, and 76% of patients had alpha angle <55°. The presurgical TEG clotting index (CI) was +2.45 ± 1.25, postreperfusion CI was -1.96 ± 4.54, and postoperative CI was +4.02 ± 1.35. Univariate analysis revealed that antithymocyte globulin was a significant, but etiology was closure to a significant level as protecting factor, but in multivariate analysis, both variables showed protecting factor with insignificant results. There was a weak correlation between CI with serum creatinine at all time points suggested no linear relationship between serum creatinine and corresponding CI. Hence, the results of study proves that IRI during renal transplant is associated with transient self-limiting coagulopathy, that may be early detected by TEG. CI values in postoperative 24 h apart indicating a hyper-coagulable or prothrombotic state and post-reperfusion CI values show a trend toward hypocoagulable status. No significant effect of different immunosuppression on coagulation and week correlation was found of serum creatinine level (graft function) with CI, which conclude that changes in coagulation have not affected graft function.

Byline: Gaurav. Sindwani, Sandeep. Sahu, Aditi. Suri, Sanjoy. Sureka, Manu. Thomas Background and Aims: Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new [...]

Background and Aims: Fluid administration during liver transplant (LT) surgery is controversial. Although adverse outcomes following positive intraoperative fluid balance have been reported, studies presenting the influence of cumulative postoperative fluid balance (CFB) on complications following LT are sparse. Patients with chronic liver disease tend to receive more fluid during and after surgery due to their unique physiological disease state. The aim of this study was to evaluate the influence of 48-hour CFB on the development of acute kidney injury (AKI) and pulmonary complications on day 4 after live donor LT. Methods: This retrospective study included 230 patients undergoing live donor LT. The effect of CFB on day 2 on AKI and pulmonary complications was analysed. Chi-square test, Fisher's exact test, samples t-test, Mann-Whitney U-test were used. Results: Bivariate analysis showed a lower graft vs recipient weight ratio (GRWR), sepsis (P < 0.001) and a higher 48-hour CFB after surgery significantly increased the development of AKI. For pulmonary complications, higher Model for End- stage Liver Disease-Na (MELD-Na) score, higher peak arterial lactate, higher 48-hour CFB (P = 0.016) and sepsis (P = 0.003) were found to be statistically significant. Upon multivariate analysis, CFB at 48 hours was significantly higher in patients suffering from pulmonary complications, and GRWR and sepsis were significant for AKI. For every one litre increase in CFB on day 2, the odds of pulmonary complications increased by 37%. Conclusion: A more positive CFB on day 2 increased the development of pulmonary complications and lower GRWR and sepsis increased the development of AKI. [ABSTRACT FROM AUTHOR]