Abstract
Background: Renal autotransplantation is a complex procedure performed for various indications such as treatment of renal vascular and urologic lesions and loin pain hematuria syndrome (LPHS). Because of the rarity of the procedure, few reports have been published, and little is known about anesthetic management and postoperative outcomes of patients with LPHS. The goal of this study was to review and describe all cases of renal autotransplantation performed at Cleveland Clinic during a specified period, focusing on anesthetic management and postoperative 30-day outcomes.Methods: We performed a retrospective review of the records of all patients who underwent renal autotransplantation from 2005 to 2014 at the Cleveland Clinic and collected demographic, anesthetic, surgical, and postoperative data.Results: A total of 64 patients underwent renal autotransplantation from 2005 to 2014. The most frequent indications were nephrolithiasis and LPHS. General endotracheal anesthesia with epidural for pain control was used in 47% of cases. Median duration of anesthesia was 528 minutes. Most patients were sent to a regular nursing floor postoperatively, but 28% of patients required intensive care unit admission. Two patients developed graft ischemia, and 1 patient developed graft failure requiring nephrectomy. No anesthetic-related complications and no mortality were associated with this procedure during the study.Conclusion: Renal autotransplantation is a safe option for patients with LPHS. Additional studies are needed to assess the effect of intraoperative anesthetic management on outcomes in this patient population.
Highlights
Renal autotransplantation is a complex procedure performed for various indications,[1] including the correction of renal vascular abnormalities and the management of intractable loin pain hematuria syndrome (LPHS).[1,2]
While renal autotransplantation is considered a last resort for the treatment of LPHS, it is the only procedure associated with long-term success, reported to be as high as 75%
Anesthetic management for renal autotransplantation can be challenging, and anesthesiologists play a critical role in preserving renal function during periods of ischemia and reperfusion.[11]
Summary
Renal autotransplantation is a complex procedure performed for various indications,[1] including the correction of renal vascular abnormalities and the management of intractable loin pain hematuria syndrome (LPHS).[1,2] Autotransplantation was first performed in 1982 for the treatment of LPHS.[3]In patients with LPHS, the pain is located in the flank region and is often progressive and crippling.[4]. Renal autotransplantation is a complex procedure performed for various indications,[1] including the correction of renal vascular abnormalities and the management of intractable loin pain hematuria syndrome (LPHS).[1,2] Autotransplantation was first performed in 1982 for the treatment of LPHS.[3]. Renal autotransplantation is a complex procedure performed for various indications such as treatment of renal vascular and urologic lesions and loin pain hematuria syndrome (LPHS). The goal of this study was to review and describe all cases of renal autotransplantation performed at Cleveland Clinic during a specified period, focusing on anesthetic management and postoperative 30-day outcomes. Methods: We performed a retrospective review of the records of all patients who underwent renal autotransplantation from 2005 to 2014 at the Cleveland Clinic and collected demographic, anesthetic, surgical, and postoperative data. Additional studies are needed to assess the effect of intraoperative anesthetic management on outcomes in this patient population
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