[Acute renal failure of the donor in encephalic death: A real contraindication to kidney transplantation?] / L'insuffisance rénale aiguë du donneur en mort encéphalique : une réelle contre-indication à la transplantation rénale ?

INTRODUCTION: The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation. MATERIALS AND METHODS: All of the transplants performed in two university hospitals between 2010 and 2017 were analyzed retrospectively. All patients who underwent single kidney transplant from a brain-dead donor with acute renal failure (ARF) were included in this study. ARI was defined here by a decrease over 50 % of glomerular filtration rate (GFR) to a threshold below 45mL/min/1.73 m2 at the time of kidney procurement. Kidney graft survival, incidence of delayed graft function (DGF) and the GFR at 12 months were analyzed. Analysis of kidney transplant survival based on pre-implantation biopsies was additionally done. RESULTS: One hundred and sixty four patients were transplanted with a kidney from donor with ARF during the selected period. At the admission in ICU the average GFR was 67,7±19mL/min/1,73m2. At the time of donation, the average age of donors was 56.4±17.7 years, the GFR was 33.7±8.0mL/min/1.73 m2 16 % of donors were anuric. Cold ischemia time (CIT) was 16.8±5.0hours. The average age of recipients was 55.6±14.1 years. 81 % of the cases were primary transplants. Graft function took place within 7.8±9.4 days after transplantation. There were two non-primary functions (PNF). One hundred and fifty two patients (93 %) had a functional graft at 12 months. The mean GFR at 12 months was 46.8±20.1mL/min/1.73 m2 and 122 patients (73 %) had a GFR greater than 30mL/min/1.73 m2. Seventy-one percent of preimplantation biopsies revealed acute tubular necrosis (ATU); no cortical necrosis was observed. Survival of theses grafts was 85 %, comparable to the total population of study (P=0,21) CONCLUSION: The acute renal failure of the brain-dead donor should not alone be systematically a contraindication to harvesting and kidney transplantation.

[Is hemodilution sufficient to avoid homologous blood transfusion in reduction mammaplasties?]. / L'hémodilution est-elle suffisante pour éviter la transfusion homologue au cours des mammoplasties de réduction?

The unpredictability of blood loss during reductive mammoplasties induced the authors to use a blood-sparing technique so as to avoid homologous transfusions. Intentional isovolaemic haemodilution (IIH) was performed in 38 patients. Clinical and biological criteria were used for analyzing the results. In this prospective study, IIH could not prevent the necessity of homologous transfusion for 3 patients, in the early postoperative period. In one of these cases, clotting of blood prevented its utilization. Therefore IIH appears to be an interesting alternative blood-sparing method in patients who cannot benefit easily from preoperative programmed blood auto-donation.

[Repeated convulsions after abrupt benzodiazepine withdrawal]. / Convulsions itératives après sevrage brutal en benzodiazépines.

Benzodiazepines are widely used and well-known for their safety; serious complications may, nevertheless, occur in the particular case of an abrupt withdrawal, which is quite common after general anaesthesia. The case reported emphasizes the seriousness of the syndrome : after vascular surgery the patient presented with repeated epileptic seizures and a short lasting cardiac arrest. The patient used to absorb large quantities of benzodiazepines, without medical prescription. The convulsions stopped after the benzodiazepine had been taken again. The exact mechanism of the withdrawal syndrome remains hypothetical. There are numerous risk factors which increase the probability and seriousness of the withdrawal symptoms. The prevention of withdrawal accidents depends on the physician, and especially the anesthetist, knowing the patient's drug intake. This shows yet again the importance of the preanaesthetic visit.