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Perioperative renal protection

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https://www.readbyqxmd.com/read/28620307/peri-and-postoperative-treatment-with-the-interleukin-1-receptor-antagonist-anakinra-is-safe-in-patients-undergoing-renal-transplantation-case-series-and-review-of-the-literature
#1
Catharina M Mulders-Manders, Marije C Baas, Femke M Molenaar, Anna Simon
In patients undergoing solid organ transplantation, the presence of an interleukin-1 (IL-1) driven disease may require the addition of IL-1 inhibiting drugs to the standard immunosuppressive regimen to protect against inflammation and negative graft outcome. Three patients undergoing renal transplantation were treated perioperatively with the interleukin-1 receptor antagonist anakinra. Kidney function increased rapidly in all three and the only complications seen were minor infections. In vitro studies report associations between serum and urinary levels of IL-1β and IL-1 receptor antagonist and negative graft outcome, and studies in animals and two small human trials illustrate a possible protective effect of anti-IL-1 therapy after solid organ transplantation...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28556989/weight-based-dosing-of-alemtuzumab-an-ounce-of-prevention
#2
Joshua J Augustine
Alemtuzumab is a lymphocyte-depleting humanized monoclonal antibody that targets CD52 and binds to T and B lymphocytes, macrophages, monocytes and natural killer cells.(1) It was approved decades ago for the treatment of B-cell chronic lymphocytic leukemia (CLL), and the use of alemtuzumab in kidney transplantation was first described in the late 1990s as a drug that could promote tolerance and allow for maintenance drug minimization.(2) Although there has been variability in dosing in renal transplantation(3-5) , alemtuzumab is typically administered at a dosage of 30 mg intravenously once or twice in the perioperative transplant period, which is a fraction the cumulative dosage used for CLL...
May 30, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28556519/lessons-learned-early-termination-of-a-randomized-trial-of-calcineurin-inhibitor-and-corticosteroid-avoidance-using-belatacept
#3
Kenneth A Newell, Aneesh K Mehta, Christian P Larsen, Peter G Stock, A Bradley Farris, Shikha G Mehta, David Ikle, Brian Armstrong, Yvonne Morrison, Nancy Bridges, Mark Robien, Roslyn B Mannon
The intent of this NIH-sponsored study was to compare a belatacept-based immunosuppressive regimen with a maintenance regimen of tacrolimus and mycophenolate (MMF). Nineteen primary, EBV-immune renal transplant recipients with a negative cross-match were randomized to one of three groups. All patient groups received perioperative steroids and maintenance MMF. Patients in groups 1 and 2 were induced with alemtuzumab and maintained on tacrolimus or belatacept, respectively. Patients in group 3 were induced with basiliximab, received 3 months of tacrolimus, and maintained on belatacept...
May 28, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28530620/-laparoscopic-ureteral-reimplantation
#4
Iván González Rodríguez, Rodrigo Gil Ugarteburu, Sergio Fernández-Pello Montes, Begoña Díaz Méndez, Rebeca Blanco Fernández, Javier Mosquera Madera
Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and perioperative complications compared to open ureteral reimplantation (OUR). The few long-term results suggest a similar success rate between the open and laparoscopic approaches...
May 2017: Archivos Españoles de Urología
https://www.readbyqxmd.com/read/28464554/does-training-of-fellows-affect-peri-operative-outcomes-of-robot-assisted-partial-nephrectomy
#5
Zine-Eddine Khene, Benoit Peyronnet, Elise Bosquet, Benjamin Pradère, Corentin Robert, Tarek Fardoun, Solène-Florence Kammerer-Jacquet, Grégory Verhoest, Nathalie Rioux-Leclercq, Romain Mathieu, Karim Bensalah
OBJECTIVE: To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS: We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group)...
May 2, 2017: BJU International
https://www.readbyqxmd.com/read/28437021/optimal-outcome-achievement-in-partial-nephrectomy-for-t1-renal-masses-a-contemporary-analysis-of-open-and-robotic-cases
#6
Matthew J Maurice, Daniel Ramirez, Önder Kara, Ercan Malkoç, Ryan J Nelson, Khaled Fareed, Robert J Stein, Amr F Fergany, Jihad H Kaouk
OBJECTIVES: To compare optimal outcome achievement between open and robotic partial nephrectomy. PATIENTS AND METHODS: Using our institutional partial nephrectomy database, we reviewed 605 cases performed for unifocal clinical T1 renal masses in non-solitary kidneys from 2011-2015. Tetrafecta, which was defined as negative surgical margins, freedom from perioperative complications, ≥80% renal functional preservation, and no chronic kidney disease upstaging, was chosen as the composite optimal outcome...
April 24, 2017: BJU International
https://www.readbyqxmd.com/read/28342285/development-of-a-human-cadaver-model-for-training-in-laparoscopic-donor-nephrectomy
#7
Erica R H Sutton, Adrian Billeter, Devin Druen, Henry Roberts, Jonathan Rice
BACKGROUND: The organ procurement network recommends a surgeon record 15 cases as surgeon or assistant for laparoscopic donor nephrectomies (LDN) prior to independent practice. The literature suggests that the learning curve for improved perioperative and patient outcomes is closer to 35 cases. In this article, we describe our development of a model utilizing fresh tissue and objective, quantifiable endpoints to document surgical progress, and efficiency in each of the major steps involved in LDN...
March 25, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28340819/influence-of-proton-pump-inhibitors-on-mycophenolic-acid-pharmacokinetics-in-patients-with-renal-transplantation-and-the-relationship-with-cytochrome-2c19-gene-polymorphism
#8
H S Ciftci, M S Karadeniz, T Tefik, Y Caliskan, H Yazıcı, E Demir, A Turkmen, I Nane, F S Oguz, F Aydin
BACKGROUND: Most patients have serious digestive complications after renal transplantation. Therefore, it is important to protect gastrointestinal function to improve the survival rate of transplant patients. Proton pump inhibitors (PPIs) such as lansoprazole and rabeprazole are widely administered to renal transplant patients with mycophenolic acid (MPA) in the perioperative period. PPIs are metabolized by cytochrome (CYP) 2C19 enzymes. Mycophenolate sodium (MYF) and mycophenolate mofetil (MMF) have been used in immunosuppression...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28331287/does-remifentanil-attenuate-renal-ischemia-reperfusion-injury-better-than-dexmedetomidine-in-rat-kidney
#9
E Erkılıç, E Kesimci, F Alaybeyoğlu, I Kılınç, R Tural, A Yazgan, T Gümüş, A Sepici Dinçel, E G Dumlu, O Kanbak
BACKGROUND: Ischemia-reperfusion (I/R) injury is a common cause of patient morbidity and mortality in the perioperative period. Patients undergoing long-lasting, abdominal, and urogenital surgeries with risk factors such as advanced age, peripheral artery disease, diabetes mellitus, renovascular disease, and congestive heart failure are candidates for acute kidney injury (AKI) due to impaired renal perfusion and decreased functional renal reserve. Pharmacological agents with multiple functions and anti-oxidative and anti-inflammation properties may be promising preventative strategies for AKI...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28274751/predictors-of-early-aortic-neck-dilatation-after-endovascular-aneurysm-repair-with-endoanchors
#10
Apostolos K Tassiopoulos, Spyridon Monastiriotis, William D Jordan, Bart E Muhs, Kenneth Ouriel, Jean Paul De Vries
OBJECTIVE: Dilatation of the aorta within the proximal neck after endovascular aneurysm repair (EVAR) can be associated with late endoleaks and migration. This study was designed to identify predictors of early neck dilation in patients undergoing EVAR with Heli-FX EndoAnchors (Medtronic, Santa Rosa, Calif) measured perioperatively to 1 year at different longitudinal levels of neck length. METHODS: The study group of Aneurysm Treatment Using the Heli-FX Aortic Securement System (ANCHOR) comprises 257 consecutive patients prospectively enrolled between April 2012 and September 2014 undergoing EVAR with Heli-FX EndoAnchor implantation at 38 investigational sites...
March 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28240954/effect-of-cold-storage-on-immediate-graft-function-in-an-experimental-model-of-renal-transplantation-in-cats
#11
Rebecca A Csomos, Robert J Hardie, Chad W Schmiedt, Fern A Delaney, Jonathan F McAnulty
OBJECTIVE To assess the effect of cold storage (CS) on immediate posttransplantation function of renal autografts in cats. ANIMALS 15 healthy 1-year-old cats. PROCEDURES Cats were assigned to 2 groups and underwent autotransplantation of the left kidney followed by nephrectomy of the right kidney. The left kidney was autotransplanted either immediately (IT group; n = 6) or after being flushed with a cold sucrose phosphate solution and stored on ice while the implant site was prepared (CS group; 9). Serum creatinine and BUN concentrations were monitored daily and autografts were ultrasonographically examined intermittently for 14 days after surgery...
March 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28224201/dexmedetomidine-protects-against-cisplatin-induced-acute-kidney-injury-in-mice-through-regulating-apoptosis-and-inflammation
#12
H Liang, H-Z Liu, H-B Wang, J-Y Zhong, C-X Yang, B Zhang
OBJECTIVE AND DESIGN: Cisplatin-based chemotherapy has been widely used in the perioperative period of cancer surgery, which exacerbates the risk of renal injury. In this study, we examined whether dexmedetomidine (DEX), a commonly used anesthetic adjuvant, shows a protective effect against cisplatin-induced acute kidney injury. MATERIALS: Acute kidney injury in mice was induced by cisplatin. TREATMENTS: Mice were administered with DEX 25 μg/kg or atipamezole 250 μg/kg (once a day, for 3 days) after cisplatin treatment...
May 2017: Inflammation Research: Official Journal of the European Histamine Research Society ... [et Al.]
https://www.readbyqxmd.com/read/28154270/reassessment-of-acute-kidney-injury-after-cardiac-surgery-a-retrospective-study
#13
Xiangcheng Xie, Xin Wan, Xiaobing Ji, Xin Chen, Jian Liu, Wen Chen, Changchun Cao
Objective To evaluate the incidence, risk, or protective factors of acute kidney injury (AKI) in patients after cardiac surgery based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Methods A retrospective analysis of 2,575 patients undergoing their first documented cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Perioperative variables were collected and analyzed. Univariate and multiple logistic regression models were used for determining the association between the development of AKI and risk factors...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28117559/anatomical-study-of-renal-arterial-vasculature-and-its-potential-impact-on-partial-nephrectomy
#14
Veronica Macchi, Alessandro Crestani, Andrea Porzionato, Maria Martina Sfriso, Aldo Morra, Marta Rossanese, Giacomo Novara, Raffaele De Caro, Vincenzo Ficarra
OBJECTIVES: To validate Graves' classification of the intrarenal arteries and to verify the absence of collateral arterial blood supply between different renal segments, in order to maximize peri-operative and functional outcomes of partial nephrectomy. MATERIALS AND METHODS: The study was performed on 15 normal kidneys sampled from eight unembalmed cadavers. Kidneys with the surrounding perirenal fat tissue were removed en bloc with the abdominal segment of the aorta...
January 24, 2017: BJU International
https://www.readbyqxmd.com/read/28110032/first-experience-open-small-incision-rectus-sheath-approach-renal-transplant-a-case-series
#15
Stephen H Phillips, Sharon K Hill, Lorie D Lipscomb, Joseph B Africa
BACKGROUND: Prevention of wound complications is an important goal in surgery, and reduction of modifiable risks factors are an important step towards protecting patients from further complications. Renal transplantation has sought to be more inclusive giving access to transplantation to complex patient populations, many of which have an increased risk of complications specifically obese recipients. Surgical techniques continue to advance and may contribute to reducing complications. We hypothesized that the Anterior Rectus Sheath (ARS) Approach would provide an open transplant with minimal damage and less wound complications, including fluid collections such as lymphoceles, when compared to the conventional technique (CON) with equivalent graft function and survival...
March 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/27988978/early-surgical-outcomes-and-oncological-results-of-robot-assisted-partial-nephrectomy-a-multicentre-study
#16
Rajan Veeratterapillay, Sanjai K Addla, Clare Jelley, John Bailie, David Rix, Steve Bromage, Neil Oakley, Robin Weston, Naeem A Soomro
OBJECTIVE: To describe a multicentre experience of robot-assisted partial nephrectomy (RAPN) in northern England, with focus on early surgical outcomes and oncological results. PATIENTS AND METHODS: All consecutive patients undergoing RAPN at four tertiary referral centres in northern England in the period 2012-2015 were included for analysis. RAPN was performed via a transperitoneal approach using a standardized technique. Prospective data collection was performed to capture preoperative characteristics (including R...
December 18, 2016: BJU International
https://www.readbyqxmd.com/read/27833481/cardiac-and-renal-protective-effects-of-dexmedetomidine-in-cardiac-surgeries-a-randomized-controlled-trial
#17
A S Ammar, K M Mahmoud, Z A Kasemy, M A Helwa
BACKGROUND: Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries. MATERIALS AND METHODS: Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27775553/a-perioperative-clinical-pathway-can-dramatically-reduce-failure-to-rescue-rates-after-cytoreductive-surgery-for-peritoneal-carcinomatosis-a-retrospective-study-of-666-consecutive-cytoreductions
#18
Guillaume Passot, Delphine Vaudoyer, Laurent Villeneuve, Florent Wallet, Annie-Claude Beaujard, Gilles Boschetti, Pascal Rousset, Naoual Bakrin, Eddy Cotte, Olivier Glehen
OBJECTIVE: To determine whether a perioperative, standardized clinical pathway could impact the failure-to-rescue rate after cytoreductive surgery (CRS) for peritoneal carcinomatosis (PC) in a tertiary center. SUMMARY OF BACKGROUND DATA: Morbidity and mortality remain significant after CRS for PC. Clinical pathways have been associated with better outcomes after surgery. The failure-to-rescue rate is a useful metric for evaluating quality in surgery. MATERIALS AND METHODS: This study included 666 patients that received CRS for PC between 2009 and 2014...
April 2017: Annals of Surgery
https://www.readbyqxmd.com/read/27699971/robot-assisted-approach-improves-surgical-outcomes-in-obese-patients-undergoing-partial-nephrectomy
#19
Ercan Malkoc, Matthew J Maurice, Onder Kara, Daniel Ramirez, Ryan J Nelson, Peter A Caputo, Pascal Mouracade, Robert Stein, Jihad H Kaouk
OBJECTIVES: To assess the impact of approach on surgical outcomes in otherwise healthy obese patients undergoing partial nephrectomy for small renal masses. PATIENTS AND METHODS: Using our institutional partial nephrectomy database, we abstracted data on otherwise healthy (Charlson comorbidity score ≤1 and bilateral kidneys), obese patients (body mass index >30 kg/m(2) ) with small renal masses (<4 cm) treated between 2011 and 2015. The primary outcomes were intra-operative transfusion, operating time, length of hospital stay (LOS), and postoperative complications...
February 2017: BJU International
https://www.readbyqxmd.com/read/27650341/organ-protection-during-aortic-cross-clamping
#20
REVIEW
Kak Khee Yeung, Menno Groeneveld, Joyce Ja-Ning Lu, Pepijn van Diemen, Vincent Jongkind, Willem Wisselink
Open surgical repair of an aortic aneurysm requires aortic cross-clamping, resulting in temporary ischemia of all organs and tissues supplied by the aorta distal to the clamp. Major complications of open aneurysm repair due to aortic cross-clamping include renal ischemia-reperfusion injury and postoperative colonic ischemia in case of supra- and infrarenal aortic aneurysm repair. Ischemia-reperfusion injury results in excessive production of reactive oxygen species and in oxidative stress, which can lead to multiple organ failure...
September 2016: Best Practice & Research. Clinical Anaesthesiology
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