Postoperative Creatinine Levels Research Articles

Effect of pre-transplantation use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in kidney transplant recipients-propensity score-matched analysis.

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARBs) can cause acute kidney injury under dehydratation or inhemodynamically unstable conditions. Regarding kidney transplantation (KT), the risk of using ACEi/ARBs before surgery is not well established. Therefore, we evaluated the clinical outcomes to determine the effect of preoperative use of ACEi/ARBs on KT. We retrospectively collected 1187 patients who received living-donor KT between January 2017 and December 2021. We conducted a propensity score-matched analysis between the ACEi/ARB(+) and ACEi/ARB(-) groups and evaluated the effects of ACEi/ARBs on delayed graft function, post-KT renal function, hyperkalemia events, rejection, and graft survival. The ACEi/ARB(+) group showed a similar incidence of delayed graft function as the ACEi/ARB(-) group (1.8% vs. 1.0%, P = 0.362). The risk of delayed graft function was not upregulated in the ACEi/ARB(+) group after propensity score-matching (odds ratio: 0.50, 95% confidence interval (CI) 0.13-2.00). Postoperative creatinine levels and the slope of creatinine levels after KT also were not significantly different between the two groups (creatinine slope from POD#0 to POD#7: -0.73 ± 0.35 vs. -0.75 ± 0.32mg/dL/day, P = 0.464). Hyperkalemia did not occur more often in the ACEi/ARB(+) group than in the ACEi/ARB(-) group during perioperative days. Rejection-free survival (P = 0.920) and graft survival (P = 0.621) were not significantly different between the two groups. In KT, the preoperative use of ACEi/ARBs did not significantly affect clinical outcomes including delayed graft function, postoperative renal function, hyperkalemia events, incidence of rejection, and graft survival rates compared to the patients who did not receive ACEi/ARBs.

Perioperative management of facial reconstruction surgery in patients with end-stage renal disease undergoing dialysis.

The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

Association of perioperative transfusion of fresh frozen plasma and outcomes after cardiac surgery.

Fresh frozen plasma (FFP) transfusion is used to manage coagulopathy and bleeding in cardiac surgery patients despite uncertainty about its safety and effectiveness. We performed a propensity score matched analysis of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database including patients from 39 centres from 2005 to 2018. We investigated the association of perioperative FFP transfusion with mortality and other clinical outcomes. Of 119,138 eligible patients, we successfully matched 13,131 FFP recipients with 13,131 controls. FFP transfusion was associated with 30-day mortality (odds ratio (OR), 1.41; 99% CI, 1.17-1.71; p < .0001), but not with long-term mortality (hazard ratio (HR), 0.92; 99% CI, 0.85-1.00; p = .007, Holm-Bonferroni α = 0.0004). FFP was also associated with return to theatre for bleeding (OR, 1.97; 99% CI, 1.66-2.34; p < .0001), prolonged intubation (OR, 1.15; 99% CI, 1.05-1.26; p < .0001) and increased chest tube drainage (Mean difference (MD) in mL, 131; 99% CI, 120-141; p < .0001). It was also associated with reduced postoperative creatinine levels (MD in g/L, -6.33; 99% CI, -10.28 to -2.38; p < .0001). In a multicentre, propensity score matched analysis, perioperative FFP transfusion was associated with increased 30-day mortality and had variable associations with secondary clinical outcomes.

Ileal ureter replacement and ileocystoplasty for the treatment of bilateral ureteral strictures and bladder contracture: technique and outcomes.

The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture. A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported. The mean age of the patients was 52.86±6.06 years. The average duration of surgery was 365±28.54 minutes, and the estimated intraoperative blood loss was 357.14±184.06 mL. The mean length of harvested ileum was 37.86±8.40 cm. The preoperative serum creatinine level was 88.02±18.05 μmol/L, postoperative day 1 creatinine level was 90.7±12.93μmol/L, postoperative 3-month creatinine level was 93.77±33.34 μmol/L, and the mean creatinine level at the last follow-up was 94.89±27.89μmol/L. The postoperative bladder capacity was 249.43±32.50 mL on average. The average length of hospital stay was 26.57±15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery. Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.

Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty

BackgroundThis study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early postoperative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral antidiabetic medications and those who switched to insulin postoperatively. The hypothesis was that continuing home medications would lead to lower BG levels without metabolic abnormalities. MethodsPatients who had diabetes who underwent primary TKA from 2013 to 2022 were evaluated retrospectively. Diabetic patients who were not on home oral antidiabetic medications or who were not managed as an inpatient postoperatively were excluded. Patient demographics and laboratory tests collected preoperatively and postoperatively as well as 90-day emergency department visits and 90-day readmissions, were pulled from electronic records. Patients were grouped based on inpatient diabetes management: continuation of home medications versus new insulin coverage. Acute postoperative BG control, creatinine levels, metabolic abnormalities, LOS, and early postoperative complications were compared between groups. Multivariable regression analyses were performed to measure associations. ResultsA total of 867 primary TKAs were assessed; 703 (81.1%) patients continued their home oral antidiabetic medications. Continuing home antidiabetic medications demonstrated lower median maximum inpatient BG (180.0 mg/dL versus 250.0 mg/dL; P < .001) and median average inpatient BG (136.7 mg/dL versus 173.7 mg/dL; P < .001). Logistic regression analyses supported the presence of an association (odds ratio = 17.88 [8.66, 43.43]; P < .001). Proportions of acute kidney injury (13.5 versus 26.7%; P < .001) were also lower. There was no difference in relative proportions of metabolic acidosis (4.4 versus 3.7%; P = .831), LOS (2.0 versus 2.0 days; P = .259), or early postoperative complications. ConclusionsContinuing home oral antidiabetic medications after primary TKA was associated with lower BG levels without an associated worsening creatinine or increase in metabolic acidosis. Level III EvidenceRetrospective Cohort Study.

Comparison of six percent hydroxyethyl starch 130/0.4 and ringer's lactate as priming solutions in patients undergoing isolated open heart valve surgery: A double-blind randomized controlled trial.

Colloids are added to the priming solution of the cardiopulmonary bypass (CPB) pump to maintain colloid osmotic pressure and prevent fluid overload. This study aimed to compare the effects of 6% hydroxyethyl starch (HES) 130/0.4 and ringer's lactate (RL) priming solution on patients' outcomes undergoing isolated heart valve surgery with CPB. This randomized clinical trial included one hundred and 20 patients undergoing heart valve surgery, and those were allocated into two groups. Patients in the RL group received 1500mL of RL, and those in the RL + HES group were given 500mL of HES and 1000mL of RL. The patients' median age was 52 (IQR 42-60) and 50 (IQR 40-61) years in the RL + HES and the RL group, respectively (p = .71). The number of cases that required blood product transfusion in both the operating room and intensive care unit was also significantly higher in the RL + HES group compared to the RL group (RR 2.04, 95% CI 1.50-2.76; p < .01 and RR 1.42, 95% CI 1.01-2.01; p = .05, respectively). Declines in postoperative creatinine levels and platelet counts were higher in the RL + HES compared to the RL group (between-subjects effect p = .007 and p = .038, respectively), while the incidence of acute kidney injury was comparable between groups (RR 0.66, 95% CI 0.13-3.30; p = .55). Among patients undergoing heart valve surgery with CPB, 6% HES added to RL for priming compared with only RL increased the risk of the need for blood product transfusion over the hospitalization period.

Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer.

Gallbladder cancer (GC) is a common malignant tumor and one of the leading causes of cancer-related death worldwide. It is typically highly invasive, difficult to detect in the early stages, and has poor treatment outcomes, resulting in high mortality rates. The available treatment options for GC are relatively limited. One emerging treatment modality is hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC involves delivering heated chemotherapy directly into the abdominal cavity. It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions, aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity. To determine the effects of cytoreductive surgery (CRS) combined with HIPEC on the short-term prognosis of patients with advanced GC. Data from 80 patients treated at the Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed. The control group comprised 44 patients treated with CRS, and the research group comprised 36 patients treated with CRS combined with HIPEC. Then, the survival time and prognostic factors of the two groups were compared, as well as liver and kidney function indices before and six days after surgery. Adverse reactions and complications were recorded in both groups. The baseline data of the research and control groups were similar (P > 0.05). Six days after surgery, the alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups (P < 0.05). However, the values did not differ between the two groups six days postoperatively (P > 0.05). Similarly, the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups (P < 0.05), but they did not differ between the groups six days postoperatively (P > 0.05). Furthermore, the research group had fewer postoperative adverse reactions than the control group (P = 0.027). Finally, a multivariate Cox analysis identified the tumor stage, distant metastasis, and the treatment plan as independent factors affecting prognosis (P < 0.05). The three-year survival rate in the study group was higher than that in the control group (P = 0.002). CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.

Renal implications of off-pump coronary artery bypass grafting: A retrospective cohort study analyzing postoperative creatinine levels

Background/Aim: Coronary artery disease is a significant health concern worldwide. While coronary artery bypass grafting is a gold standard of treatment, acute kidney injury (AKI) is a possible postoperative complication of concern. Off-pump coronary artery bypass grafting (OPCABG) aims to curtail perioperative complications; however, its impact on postoperative AKI is debated. This retrospective study aims to inform patient care by identifying potential effects of OPCABG on AKI utilizing postoperative creatinine alterations. Methods: This retrospective study was conducted at Koç University Hospital in Istanbul, Turkey. We reviewed the records of patients who underwent OPCABG between June 2018 and June 2019. Patients with incomplete records or individuals who had undergone renal replacement therapy prior to surgery were excluded. The primary metric was serum creatinine levels, which were assessed preoperatively and up to 7 days postoperatively. Preoperative creatinine levels were compared with postoperative levels using the Wilcoxon signed-rank test. Acute kidney injury was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Seventy-two patients satisfied the inclusionary criteria. A significant increase in creatinine was observed on postoperative Day 1 (P&lt;0.001); creatinine levels fell below baseline by postoperative Day 4 and 5. We note that the incidence of AKI was low; there were no instances of Stage 2 or higher AKI during the observation period. Conclusion: Our data suggest that OPCABG may result in a transient increase in creatinine post-surgery. Creatinine levels normalize over time, implicating the renal safety of OPCABG. Despite these promising findings, additional comprehensive studies are essential to validate these observations and assess long-term renal outcomes after OPCABG.

The effect intraoperative positive end expiratory pressure and tidal volume on postoperative acute kidney injury after orthopedic surgery.

To test whether higher intraoperative PEEP levels and/or higher TV levels are associated with higher incidence of postoperative AKI within the first postoperative week, in adult patients having orthopedic surgeries under general anesthesia. We conducted a sub analysis of a non-randomized alternating intervention cross over study performed in patients undergoing orthopedic surgery under general anesthesia at Cleveland Clinic, Cleveland, OH. We included four different combinations of PEEP (5 or 8 cm H2 O) and TV (6 or 10 mL/kg of PBW) that alternated each week in the six orthopedic operating rooms. Our primary outcome was postoperative AKI defined by the KDIGO criteria with baseline creatinine as the closest preoperative value to the time of surgery obtained within 30 days and postoperative value as the highest creatinine value within 7 days after surgery. Secondary outcome was the maximum postoperative in-hospital creatinine level within seven postoperative days. A total of 1933 patients were included in the analysis. The incidence of AKI was 6.8% in the study population and similar in high TV versus low TV group and high PEEP versus low PEEP group. Neither TV nor PEEP significantly impacted AKI incidence. The estimated odds ratio of AKI comparing TV = 6 mL/kg to TV = 10 mL/kg was 0.96 (97.5% CI: 0.63, 1.46; p = .811); while the estimated odds ratio of AKI comparing PEEP = 5cm H2 O to PEEP = 8cm H2 O was 0.92 (97.5% CI: 0.60, 1.39; p = .623). No interaction was found between TV and PEEP on AKI. Additionally, neither TV nor PEEP had a significant effect on the seven postoperative day creatinine levels. Higher levels of PEEP or TV during mechanical ventilation in adult patients undergoing orthopedic surgeries under general anesthesia do not increase the odds of developing postoperative AKI within the narrow limits studied.

WTP2.10 A retrospective study of effect of donor obesity on fibrosis and kidney outcome in live donor kidney transplantation

Abstract Aims Donor obesity has increased over the last decade. The aim of this study was to assess the effect of donor obesity on fibrosis in pre-implantation biopsy and kidney outcomes in live kidney transplants. Methods A series of 288 live kidney donors between 1998 and 2010 were studied. The series was divided into three groups according to the donor Body Mass Index (BMI); Normal BMI 17-24.9 (n=119), overweight BMI 25–29.9 (n=118) and obese BMI ≥30 (n=51). Donor and recipient demographics were gathered and recipient post-transplant renal function up to five years was retrieved. Fibrosis level in pre-implantation biopsies was analysed and graft and recipient survival were assessed. Results Hypertension and live kidney donor profile index LKDPI were statistically significantly higher in obese donors compared with non-obese donors (p=0.004 and p&amp;lt;0.001 respectively). Donor creatinine levels for obese group were comparable to the other two groups over three post-operative years (p=0.933). Fibrosis analysis showed no statistically significant difference among the three BMI groups (p=0.063). Donor obese group had statistically significant higher 5 year graft and patient loss rate compared with non-obese BMI groups (p=0.018 and p=0.015 respectively). Recipient post-operative creatinine levels showed no statistically significant differences among the three BMI groups (p=0.393). Similarly, fibrosis in pre-implantation biopsies had no statistically significant impact on recipient post-operative creatinine levels (p=0.243). Conclusions Donor obesity has no significant impact on fibrosis in the pre-implantation biopsy and on recipient post-operative kidney function. However, Donor obesity results in lower five-year graft and patient survival rate.

Prediction of Postoperative Creatinine Levels by Artificial Intelligence after Partial Nephrectomy.

Background and Objectives: Multiple factors are associated with postoperative functional outcomes, such as acute kidney injury (AKI), following partial nephrectomy (PN). The pre-, peri-, and postoperative factors are heavily intertwined and change dynamically, making it difficult to predict postoperative renal function. Therefore, we aimed to build an artificial intelligence (AI) model that utilizes perioperative factors to predict residual renal function and incidence of AKI following PN. Methods and Materials: This retrospective study included 785 patients (training set 706, test set 79) from six tertiary referral centers who underwent open or robotic PN. Forty-four perioperative features were used as inputs to train the AI prediction model. XG-Boost and genetic algorithms were used for the final model selection and to determine feature importance. The primary outcome measure was immediate postoperative serum creatinine (Cr) level. The secondary outcome was the incidence of AKI (estimated glomerular filtration rate (eGFR) < 60 mL/h). The average difference between the true and predicted serum Cr levels was considered the mean absolute error (MAE) and was used as a model evaluation parameter. Results: An AI model for predicting immediate postoperative serum Cr levels was selected from 2000 candidates by providing the lowest MAE (0.03 mg/dL). The model-predicted immediate postoperative serum Cr levels correlated closely with the measured values (R2 = 0.9669). The sensitivity and specificity of the model for predicting AKI were 85.5% and 99.7% in the training set, and 100.0% and 100.0% in the test set, respectively. The limitations of this study included its retrospective design. Conclusions: Our AI model successfully predicted accurate serum Cr levels and the likelihood of AKI. The accuracy of our model suggests that personalized guidelines to optimize multidisciplinary plans involving pre- and postoperative care need to be developed.

Renal perfusion improvement in the perioperative period after unilateral endovascular revascularization in patients with atherosclerotic renal artery stenosis.

The clinical benefits of endovascular treatment in renal artery stenosis (RAS) remain controversial. This study used an intraoperative renal perfusion imaging technique, called flat-panel detector parenchymal blood volume imaging (FD-PBV), to observe the change in renal perfusion after endovascular treatment in RAS. In a prospective, single-center study, we assigned 30 patients with atherosclerotic RAS who underwent endovascular treatment between March 2016 and March 2021. The preoperative and postoperative results of renal perfusion, blood pressure, and renal function, were compared. Both median kidney volume (p < 0.001) and median preoperative mean density of contrast medium (MDCM) (p = 0.028) increased significantly after endovascular treatment. The ratio of postoperative and preoperative MDCM differed greatly among the patients. For patients with preoperative MDCM <304.0 HU (Subgroup A, 15 cases), MDCM significantly increased after treatment (p = 0.001) and 12 (80.0%) patients had more than 10% increase in renal perfusion. For patients who had relatively high preoperative renal perfusion (MDCM ≥304.0 HU, Subgroup B, 15 cases), preoperative and postoperative MDCM were similar (p = 0.776). On the other hand, the serum creatinine levels significantly decreased in Subgroup A (p = 0.033) and fewer antihypertensive drugs were used after endovascular revascularization (p = 0.041). The preoperative and postoperative creatinine levels and number of antihypertensive drugs were similar in Subgroup B. During the perioperative period, RAS patients with relatively low preoperative renal perfusion levels had greater improvement in renal perfusion, renal function, and blood pressure control after endovascular treatment. The improvement of renal function needs to be confirmed by long-term follow-up.

Acute Kidney Injury Following Paediatric Cardiac Surgery: Experience of A Paediatric Cardiac Center of Bangladesh

Background: Acute kidney injury following cardiac surgery in children is a relatively common phenomenon. The risk ranges from 15% to 64% with a mortality rate of 10% to 89% for those who need dialysis.&#x0D; Objective: To identify the occurrence of acute kidney injury following cardiac surgery in children, as well as its consequences and treatment options.&#x0D; Methods: This study was conducted in the pediatric cardiac recovery center at Bangladesh Shishu Hospital &amp; Institute from January 2019 to December 2020. Using the KDIGO (kidney disease improving global outcome) criteria, 50 children having cardiac surgery were assessed for the occurrence of AKI. Children were divided into two groups. The AKI group consists of 20 patients, whereas the non-AKI group consists of 30 patients. Age, sex, cardiac illness, past operations, RACHS-1 (Risk adjustment for congenital Heart surgery) and pre and post-operative creatinine levels were noted. Fisher’s exact test was used to determine whether or not AKI was associated with categorical factors, while the Mann- Whitney U-test was used to see whether or not AKI was associated with continuous variables.&#x0D; Results: Mean age of study population was 4.50±4.03 years for those who did not develop AKI and 7.55±5.79 years for those who did. Male constituted a majority in both groups. Despite the fact that patients with AKI were more acidotic at baseline, lower bicarbonate levels were not linked to an increased risk of AKI (p=0.89). Neither group had higher or lower pressure than the other. Time spent in bypass and crossclamping was comparable across AKI and non-AKI patients. Patients with AKI did not have a higher risk of developing extracellular fluid excess than non-AKI patients. There was no significant difference between the groups in terms of the average time spent on mechanical ventilation or total hospital stay in days (p=0.17 and p=0.62, respectively). Duration of stay in the cardiac recovery increased for patients who had AKI (p=0.02). The mortality rate among the AKI patients was 20% (4/14). In the control group without AKI, there was one death (3.33%) (p 0.0001).&#x0D; Conclusion: AKI is common complication of paediatric cardiac surgery. Prolong times spent on mechanical ventilation in the ICU and in the hospital have all been linked to AKI.&#x0D; DS (Child) H J 2021; 38(1): 44-48

Single-Center Retrospective Subgroup Analysis of "Primary Aortic" (Aneurysm, Aortic Dissection, PAU) and "Secondary Aortic" (Iatrogenic, Trauma, Aortoesophageal Fistula) Indications for Emergency TEVAR.

The aim of this study was to analyze the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of "primary aortic" (aneurysm, aortic dissection, penetrating aortic ulcer (PAU)) and "secondary aortic" (iatrogenic, trauma, and aortoesophageal fistula) pathologies. Retrospective review of a cohort of patients treated at a single tertiary referral center from 2015 to 2021. The primary end point was postoperative in-hospital mortality. Secondary end points were the duration of the procedure, duration of postoperative intensive care treatment, length of hospital stay, and the nature and severity of postoperative complications according to the Dindo-Clavien classification. A total of 34 patients underwent TEVAR for emergency indications. Twenty-two patients were treated for primary and twelve patients for secondary aortic pathologies. Concerning in-hospital mortality, no statistically significant difference could be observed between the primary and secondary aortic groups (27.3% vs. 33.3%, p = 0.711). Patients with an aortoesophageal fistula had a mortality rate of 66.7%. Postoperative morbidity (Dindo-Clavien > 3) was also not statistically significantly different between the primary and secondary aortic groups (36.4% vs. 33.3%, p = 0.86). Preoperative hemoglobin level (p < 0.001 for mortality, p = 0.002 for morbidity), hemoglobin level difference (p = 0.022, p = 0.032), postoperative creatinine level (p = 0.009, p = 0.035), and pre- and postoperative lactate levels (p < 0.001 for both mortality and morbidity) were found to be independent factors associated with postoperative mortality and morbidity (Dindo-Clavien > 3), respectively. The preoperative creatinine level was found to be associated with mortality (p = 0.024) but not morbidity. Morbidity and in-hospital mortality are still considerable after emergency TEVAR for both primary and secondary aortic indications. Pre- and postoperative levels of hemoglobin, creatinine, and lactate may be valuable to predict patient outcomes.

A HIGH PREOPERATIVE NEUTROPHIL-LYMPHOCYTE RATIO AS AN INDICATOR OF EARLY RESPONSE OF KIDNEY TRANSPLANT

Objective: This study aims to evaluate the association of the preoperative Neutrophil-lymphocyte ratio (NLR) and postoperative creatinine levels after kidney transplantation, which is a predictor factor for determining early postoperative transplantation complications. Material &amp; Methods: We conducted a retrospective study of 33 patients enrolled in Sardjito General Hospital in Yogyakarta between 2017 and 2020. In this study, we observed the preoperative NLR and compared it with the postoperative creatinine level. The data were compared and analyzed. Results: This study showed that preoperative NLR in these 33 patients was 4.17 + 2.82. Postoperative creatinine levels were 2.38 + 1.75 mg/dL. Postoperative creatinine levels were higher in patients with low preoperative NLR (p=0.00). Besides, the correlation is weak and had a positive correlation direction (r=0.379). Conclusion: This study showed preoperative NLR and the postoperative serum creatinine level is correlated even weakly. NLR could be considered a predictor factor for determining postoperative transplantation complications, and even it still needs further research.

Does the Use of Mini-Incisions In Renal Transplantation Surgery Affect Postoperative Parameters: Single Center Experience

Kidney transplantation can be performed with different surgical approaches, such as conventional open kidney transplantation (CKT), minimally invasive kidney transplantation (MIKT), laparoscopic kidney transplantation, and robot-assisted kidney transplantation. Conventional open kidney transplantation is usually performed using a Gibson or hockey stick incision, may be associated with higher wound complication rates, and results in worse cosmetic outcomes compared with minimally invasive methods. Minimally invasive kidney transplantation is performed with a smaller skin incision than CKT but may result in limited surgical exposure. This study aimed to compare the surgical results of MIKT and CKT. Fifty-nine patients with a body mass index of 22 kg/m2 and below and with no anatomic variations in computed tomography were included in the study. Thirty-seven patients who underwent CKT were included in group 1, and twenty-two patients who underwent MIKT were included in group 2. Patient data were collected retrospectively. This study was conducted in compliance with The Helsinki Congress and The Declaration of Istanbul. The mean incision length was calculated as 12.7 cm in group 1 and 7.3 cm in group 2 (P < .05). There was no statistically significant difference between the groups in terms of lodge preparation time, vein clamp time, artery clamp time, ureteroneocystostomy time, visual analog scale scores, postoperative creatinine levels, or complication rates (P > .05 for each comparison). Without compromising the goals and primary concerns of transplantation surgery, MIKT can be offered to selected transplant patients with cosmetic concerns.

The Impact of Intraoperative Graft Blood Flow Measurement on Early Graft Function

The aim of this study is to evaluate the impact of intraoperative allograft vascular flow on early kidney graft function. A total of 159 patients underwent kidney transplantation from January 2017 to March 2022 at Linkou Chang Gung Memorial Hospital. Graft arterial and venous blood flow was measured separately with a transient time flowmeter (Transonic HT353; Transonic Systems, Inc, Ithaca, NY, United States) after ureteroneocystostomy. The early outcomes, including the postoperative creatinine level, were analyzed accordingly. There were 83 males and 76 females, with a mean age of 44.5 years. The mean graft arterial flow measured was 480.6 mL/min, and the mean venous flow was 506.2 mL/min. Delayed graft function (DGF) incidence was 36.5%, 32.5%, and 40.8% in total, living, and deceased donor groups, respectively. Living donor and deceased donor kidney transplantation were analyzed separately. In the DGF subgroup, there were lower graft venous flows, higher body mass index (BMI), and more male patients in the living kidney transplant group. Similarly, the deceased donor kidney transplantation group with delayed graft function tended to have higher body height, higher body weight, higher BMI, and more diabetes mellitus. The multivariate analysis showed that lower graft venous blood flow (odds ratio [OR]=0.995, P=.008) and higher BMI (OR=1.144, P=.042) were significantly correlated with delayed graft function in living donor kidney transplantations. In the deceased donor group, a multivariate analysis of risk factors showed that BMI had a significant correlation with delayed graft function (OR=1.41, P=.039). Graft venous blood flow was significantly associated with delayed graft function in living donor kidney transplantation, and high BMI was correlated with DGF in all patients receiving kidney transplantation.

NOVEL TECHNIQUE OF SHORT-ACTING SPINAL ANAESTHESIA FOR FRACTURE NECK OF FEMUR SURGERY ALLOWING EARLY MOBILIZATION, REDUCING MORBIDITY AND MORTALITY, AND IMPROVING OVERALL FUNCTIONAL OUTCOME

Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and anaesthesia may have an implication on early post-operative mobilisation.Aim was to evaluate perioperative blood pressure measurements (duration of fall of systolic BP below the critical level of 90mmHg) and effect on the post-operative renal profile with the newer short acting spinal anaesthetic agent (prilocaine and chlorprocaine) used alongside the commonly used regional nerve block. 20 patients were randomly selected who were given the newer short acting spinal anaesthetic agent along with a regional nerve block between May 2019 and February 2020. Anaesthetic charts were reviewed from all patients for data collection. The assessment criteria for perioperative hypotension: Duration of systolic blood pressure less than 90 mm of Hg and change of pre and post operative renal functions.Only one patient had a significant drop in systolic BP less than 90mmHg (25 minutes). 3 other patients had a momentary fall of systolic BP of less than 5 minutes. None of the above patients had mortality and had negligible change in pre and post op renal function. Only one patient in this cohort had elevation of post-operative creatinine levels but did not have any mortality. Only 1 patient died on day 3 post operatively who had multiple comorbidities and was under evaluation for GI cancer. Even in this patient the peri-operative blood pressure was well maintained (never below 90mmHg systolic) and post-operative renal function was also shown to have improved (309 pre-operatively to 150 post-operatively) in this patient.The use of short-acting spinal anaesthesia has shown to be associated with a better control of blood pressure and end organ perfusion, less adverse effects on renal function leading to early mobilisation and a more favourable patient outcome with reduced mortality, earlier mobilisation, shorter hospital stay and earlier discharge in this elderly patient cohort.

Frequency of Postoperative Acute Kidney Injury and its Related Risk Factors in Patients Undergoing Major Orthopedic Surgery in Rasht, Iran

Background: Patients who undergo major orthopedic surgery are at risk of acute kidney injury (AKI) due to blood loss, electrolyte disorders, infection, and other co-morbidities. In this study, we aim to investigate the frequency of AKI and its risk factors in patients undergoing major orthopedic surgery in Rasht, Iran. Objective: This is an analytical cross-sectional study on 180 patients undergoing major orthopedic surgery. Those with a history of chronic kidney disease and dialysis were excluded. Methods: The data including patients’ age, gender, drug history, history of underlying diseases, duration of surgery, mean arterial pressure during and after surgery, and use of inotrope during and after surgery, and creatinine level before and after the surgery. Results: The mean age of patients was 47.3±22.8 years. The incidence of AKI was 11.11%. The use of some drugs, duration of surgery, MAP, and inotrope use had no significant relationship. The occurrence of AKI had a significant relationship with the history of heart disease, diabetes, and kidney disease. Multiple linear regression analysis results showed that with the increase of one unit in preoperative creatinine level, the postoperative creatinine level increased by 0.3. Conclusion: The incidence of AKI after major orthopedic surgery in Rasht city is relatively high. Careful monitoring of kidney function before, during, and after major orthopedic surgery is important; it can prevent the occurrence of postoperative AKI.

Is the Presence of 2 Renal Allograft Arteries Associated with Adverse Outcomes in Live Donor Kidney Transplantation?

Although it was postulated that renal grafts with multiple arteries could lead to unfavorable recipient outcomes, this subject remains controversial. This study aimed to compare the outcomes of recipients receiving renal allografts with a single artery with those receiving renal grafts with two arteries. Adult patients who received live donor kidney transplantation in our center between January 2020 and October 2021 were included. Data including age, gender, body mass index, renal allograft side, pre-kidney transplantation dialysis status, human leukocyte antigen mismatch number, warm ischemia time, the number of renal allograft arteries (single/double), complications, duration of hospitalization, postoperative creatinine levels, glomerular filtration rates, early graft rejection, graft loss, and mortality were collected. Subsequently, patients who received single-artery renal allografts were compared with those who received double-artery renal allografts. Overall, 139 recipients were included. The mean recipient age was 43.73 ± 13.03 (21-69). While 103 recipients were male, 36 were female. The comparison between the 2 groups revealed that mean ischemia time was significantly longer in the double-artery than in the single-artery group (48.0 vs. 31.2 minutes) (P=.00). In addition, the single-artery group had significantly lower postoperative day 1 and day 30 mean serum creatinine levels. Also, the mean postoperative day 1 glomerular filtration rates were significantly higher in the single-artery group than in the double-artery group. However, the 2 groups were similar concerning the glomerular filtration rates measured at other times. On the other hand, there was no difference between the 2 groups regarding duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates. The presence of 2 renal allograft arteries does not have adverse effects on the postoperative parameters of the kidney transplantation recipients, including graft function, duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates.