The perioperative management of simultaneous bilateral nephrectomy with renal transplantation : a case series

© 2021. Canadian Anesthesiologists' Society..

PURPOSE: Bilateral nephrectomy is performed at times with renal transplantation. Though surgical indications and timing of these two procedures have been described, there are no large case series describing the anesthetic management of these cases. We sought to describe our experience.

METHODS: We performed a historical cohort study on 54 consecutive cases of simultaneous bilateral nephrectomy with renal transplantation at a single, tertiary-care medical centre. Descriptive statistics were used.

RESULTS: The most common etiology of kidney disease involved was autosomal dominant polycystic kidney disease at 52/54 (96%) cases. All patients received grafts from living donors. An arterial line was placed in 44 (81%) and a central venous catheter in 16 (30%) subjects. At least one vasopressor infusion was used in 44 (81%) cases and 37 (69%) patients required admission to the intensive care unit (ICU). Of this subset, 30 (81%) were admitted for ongoing vasopressor support and six (16%) for hemodynamic monitoring. All patients were extubated in the operating room upon completion of the procedure. Median [interquartile range (IQR)] ICU length of stay (LOS) was 0.9 [0.7-1.4] days and total hospital LOS was 4.4 [4.3-5.4] days. There were no cases of mortality at 30 days or of postoperative dialysis.

CONCLUSIONS: Adult patients undergoing simultaneous bilateral nephrectomy with renal transplantation often developed perioperative hypotension requiring vasopressor infusions and postoperative transfer to the ICU. This is possibly due to a temporary loss of the renin-angiotensin system. Despite this, patients most commonly were transferred to the floor on postoperative day 1 and had successful outcomes with no mortality at 30 days.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:68

Enthalten in:

Canadian journal of anaesthesia = Journal canadien d'anesthesie - 68(2021), 8 vom: 13. Aug., Seite 1254-1259

Sprache:

Englisch

Weiterer Titel:

Prise en charge périopératoire des néphrectomies bilatérales réalisées simultanément avec une transplantation rénale : une série de cas

Beteiligte Personen:

Hofer, Ryan E [VerfasserIn]
Kor, Todd M [VerfasserIn]
Prieto, Mikel [VerfasserIn]
Findlay, James Y [VerfasserIn]

Links:

Volltext

Themen:

Bilateral nephrectomy
Journal Article
Perioperative management
Renal transplantation

Anmerkungen:

Date Completed 04.08.2021

Date Revised 23.03.2022

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1007/s12630-021-01989-1

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM324019114