Plasma neutrophil gelatinase-associated lipocalin and Interleukin-18 as predictors of acute kidney injury in renal transplant recipients: A pilot study.

Urine neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL- 18) have shown promise for predicting renal graft recovery. However, urinary flow rate variations may cause variable biomarker dilution. Plasma NGAL and IL-18 may form a biomarker panel that may help predict delayed graft function and slow graft function (SGF) in renal transplant recipients within the first two postoperative days earlier than serum creatinine. There are only a few studies in the literature using plasma NGAL for predicting renal graft recovery. Hence, we planned this study. This observational single-center, prospective cohort study was conducted in renal transplant recipients above 18 years of age. In 22 consecutive renal transplant recipients, we collected ethylenediaminetetraacetic acid-plasma samples 1 h before surgery and subsequently at 6 h, 24 h, and 48 h after surgery for NGAL and IL-18 by sandwich enzyme-linked immuno-sorbent assay technique. Serum creatinine was measured as a part of routine transplant protocol. In renal transplant recipients, neither serum levels of NGAL and IL-18 nor their trends could reliably predict SGF. The only significant correlation existed between serum creatinine at day 2 and IL-18 at day 2 with P = 0.023. Serum NGAL did not correlate with serum creatinine in this setting of renal transplantation. Patients with immediate graft function had a greater percentage decrease of creatinine at day 1 and day 2 (P = 0.002 and 0.001) The percentage change in IL-18 at 24 h and 48 h after transplant from baseline could predict the occurrence of early graft loss (EGL) (P = 0.05, 0.04). The cutoffs were -4.12% at day 1 and +3.39% at day 2 with area under receiver operator characteristics of 0.82 and 0.83, respectively. The percentage change in IL-18 may be a useful marker of EGL in renal transplant recipients. Serum NGAL and creatinine were not able to predict EGL.

Critical events during intra-hospital transport of critically ill patients to and from intensive care unit.

OBJECTIVES: Intensive care unit (ICU) patients are at an increased risk of many catastrophic events during intrahospital transport (IHT) for various procedures. This study was planned to determine the incidence and types of adverse events occurring during the transport of critically ill patients in a tertiary care hospital. METHODS: This prospective observational study was conducted in the ICU of a tertiary care hospital for 8 months after ethical clearance from the institute ethics committee. All patients transported out of the ICU during the audit period for diagnostic or therapeutic procedures were included in the study. Vitals and several study parameters were recorded before, during, and after shifting patients to and from the ICU. Various critical events were noted during transport and classified into major and minor critical events based on the presence and absence of potential consequences that lead to a change of therapy during transport. RESULTS: One hundred and sixty patients were studied for consecutive IHT to and from the ICU. The patients were transported for imaging studies (58.1%), minor surgery (31.8%), major surgery (2.5%), and other procedures (7.5%). A total of 248 critical events were observed in 104 IHTs (65%; 95% confidence interval [95% CI]: 57.4%-72.1%). Hence, an average of 2.38 critical events occurred per IHT. There were 31 major events among the 248 critical events (12.5%; 95% CI: 8.8%-17.1%). CONCLUSIONS: Standard guidelines about the accompanying personnel and monitoring need to be followed during IHT. Conduct of minor surgical procedures in the ICU and better bedside diagnostic procedures may be considered for the future.

Study of anatomical variations of hepatic vasculature using multidetector computed tomography angiography.

PURPOSE: Preoperative evaluation of the hepatic vasculature is necessary to minimize mortality and morbidity during various surgeries due to the complexity of liver anatomy. The purpose of our investigation is to determine the anatomical variations in the hepatic vascular system by using multidetector computed tomography. METHODS: In this observational study, 500 patients aged between 1 and 86 years were randomly chosen from a patient population referred for computed tomography angiography for various clinical indications. Multidetector computed tomography angiography examinations were performed using a 128 detector scanner. The area from the lower thoracic spine to symphysis pubis level, with the patient in a supine position, was adopted as the field of view. The percentage of occurrence of each of the vascular variant was determined. RESULTS: Normal arterial anatomy [Type I] was seen in 306 patients [61.2%]. Replaced left hepatic artery from the left gastric artery was the most common variant in our study, which was seen in 57 patients [11.4%]. Classic hepatic venous anatomy was found in 261 [52.2%] patients. An accessory inferior right hepatic vein was found in 110 [22%] patients. A large early branch of segment VIII into middle hepatic vein was found in 157 patients [31.4%]. Extraparenchymal branching of the right anterior portal vein from the left portal vein was the most common anomaly found in 12 [2.4%] patients. CONCLUSIONS: Computed tomography angiography can be used in preoperative evaluation in various hepatobiliary surgeries and interventional procedures, which give a lot of information regarding parenchyma and vascular system.

Preoperative Glycated Haemoglobin Level and Postoperative Morbidity and Mortality in Patients Scheduled for Liver Transplant.

BACKGROUND: There is high prevalence of diabetes mellitus in patients of end stage liver disease and it has been implicated for complications in post-transplant patients. Glycated hemoglobin is now targeted as a modifiable preoperative risk factors for postoperative complications. Data describing the course and severity of postoperative liver transplant complication and their relation with pre-operative glycated hemoglobin level is sparse. In this study, we looked for co-relation between the preoperative HbA1c level and post-operative mortality and morbidity in patients scheduled for liver transplant. MATERIALS AND METHODS: Retrospective data in 400 adult patients operated for liver transplant were retrieved. After exclusion, data were analyzed for 224 patients. Patients were divided into two groups on the basis of glycated hemoglobin levels (Group 1 (HbA1C ≥6.5) and Group 2 (HbA1C <6.5)). RESULTS: Glycated hemoglobin levels were not associated with postoperative death during stay in intensive care unit, incidence of postoperative cardiovascular, renal, and central nervous complications. No difference was seen between 2 groups for need for renal replacement therapy, incidence of infections, rejection, need for re-exploration surgery and duration of intensive care unit and hospital stay. Glycated hemoglobin cannot predict 30 day survival (Area under curve {AUC} = 0.629, P value 0.05). CONCLUSION: Preoperative glycated hemoglobin level is not associated with postoperative morbidity and mortality in patients scheduled for liver transplant. TRIAL REGISTRATION NUMBER: CTRI/2018/04/012966.