The relevance between graft preservation solutions and QTc interval during living donor kidney transplantation and rat cardiomyocytes sampling.

BACKGROUND: The purpose of the retrospective study was to identify the impacts of different solutions on the electrocardiogram and cardiovascular changes. Moreover, the differences between these solutions were analyzed by examining their impacts on rat ventricular cardiomyocytes. METHODS: Eighty renal transplant patients were evaluated retrospectively. The patients were divided into two groups: Group UW (n =40) used the University of Wisconsin solution, and Group HTK (n =40) used the Histidine-Tryptophan-Ketoglutarate solution. Electrocardiograms of the subjects were obtained three times at different periods; during the pre-perfusion, intraoperative kidney reperfusion, and postperfusion phase at the end of the surgery. Any Electrocardiogram or cardiovascular alterations were noted and analyzed. Adult male Wistar rats were used for in vitro experiments. Myocyte contractility, action potentials, and membrane current were recorded in enzymatically isolated ventricular myocytes. RESULTS: Sinus bradycardia was detected in 19 patients of Group UW, while there was short-term asystole in eight patients. However, no cardiac changes were observed in Group HTK patients. In both Groups, reperfusion and postperfusion corrected QT (QTc) intervals were different from pre-perfusion QTc intervals. Group UW patients' reperfusion and postperfusion QTc's values were higher than those of the Group HTK patients. In rat myocytes, prominent asystole episodes were observed at specific concentrations of the UW solution compared to the HTK solution. The UW solution depolarized the resting membrane potential significantly and decreased the peak value of action potential, whereas the HTK solution did not elicit a significant change in those parameters. Accordingly, the UW solution elicited a significant inward current at -70 mV, while the HTK solution activated only a modest current, which may not change the membrane potential. CONCLUSION: Prolongation of QTc intervals was detected with reperfusion in both groups according to electrocardiography analysis. However, the QTc interval was observed to be longer in cases using the UW solution and required intervention intraoperatively. HIPPOKRATIA 2021, 25 (1):22-30.

Living donor kidney transplantation after desensitization in cross-match positive high sensitized patients.

BACKGROUND: We aimed to evaluate the long-term results of the patients who had positive cross-match (XM) test results and underwent living donor renal transplantation after desensitization with different combinations of intravenous immunoglobulin (IVIG), plasmapheresis (PP), and rituximab. MATERIAL AND METHODS: Forty-nine patients who were positive for complement-dependent cytotoxicity (CDC), flow cytometric (FC), and Luminex-XM test were included in the study. Renal transplantation was performed in 16 patients who had XM (-) test after desensitization with different combinations of IVIG (n =15), PP (n =13), and rituximab (n =10). Anti-human leukocyte antigens (HLA) antibodies (anti-HLA Abs) were detected by the Luminex single antigen bead assay. Anti-thymocyte globulin was used for induction, and tacrolimus, mycophenolic acid, and prednisolone were used for maintenance therapy. Also, we evaluated the relationship between different donor-specific anti-HLA Abs and the parameters mentioned above. RESULTS: Antibody-mediated rejection (AMR) and acute T cell-mediated rejection rates were 18.8 % and 6.3 %, respectively. Graft survival rates at the first, third, and fifth years post-transplantation were 93.8 %, 85.2 %, and 85.2 %, respectively, and the patients' survival rates were found to be 100 %. Serum creatinine level and glomerular filtration rate were 1.5 ± 1.2 mg/dl and 69.9 ± 30.4 ml/min, respectively. The mean follow-up time was 39 ± 24 months. CONCLUSIONS: Our study showed that kidney transplantation could be performed by effective desensitization in XM test positive patients. It was also shown that donor-specific anti-HLA DQ Ab and non-HLA Ab determination might be useful in diagnosing patients with positive cross-test and/or diagnosis of AMR. HIPPOKRATIA 2020, 24(4): 182-190.

Effect of Alprazolam as a Preoperative Adjuvant Analgesic on Postoperative Pain in Laparoscopic Donor Nephrectomy Patients.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of alprazolam, administered at different doses, for the control of adjuvant analgesia in laparoscopic donor nephrectomy patients preoperatively in the Akdeniz University Organ Transplantation Center, using various pain scales. MATERIALS AND METHODS: Only patients with a body mass index ≤28 kg/m2, aged between 18 and 65 years old, and with an American Society of Anesthesiologists score of 1 to 2 were included in the study. The patients were studied in 3 groups, which were given 0.5 mg alprazolam (group 1), 1 mg alprazolam (group 2), or no alprazolam (group 3) in the preoperative period. Collected data were evaluated for preoperative, intraoperative, and postoperative periods. RESULTS: There were 75 patients (31 men, 44 women). Mean age was 43.1 years. Twenty-five patients were evaluated in all 3 groups. Mean operation time was 137.8 minutes. There was no statistical difference among the groups in the duration of administered alprazolam before the operation, on the Ramsey sedation score, verbal pain score, or numeric pain score, and duration of administered first analgesic in the postoperative period. Additional dose of analgesics were administered in 7, 7, and 11 of the patients in group 1, group 2, and group 3, respectively. We found a significant difference between groups 1 and 2 in blood pressure (P = .017 and P = .014). We found a significant difference in group 1 in heart rate (P = .002). CONCLUSION: More effective analgesia protocols need to be identified for pain control in patients of laparoscopic donor nephrectomy. It is thought that the effectiveness of pain control may increase the number of donors and progress in the treatment of patients with renal failure.

Renoportal anastomosis in living donor liver transplantation.

BACKGROUND:  In advanced cirrhotic patients, extensive mesenteric vein thrombosis extends the operative time, causes peri- and postoperative complications, and increases the mortality and morbidity in liver transplantation (LT). The anastomosis between the left renal vein and graft portal vein is one of the crucial options in such patients. However, especially in living donor liver transplantation (LDLT) practice, limited cases are published in the literature. CASE REPORT: A thirty-seven years old female patient with hepatitis B virus (HBV) associated liver cirrhosis underwent LDLT. Her body mass index, graft weight, and graft-recipient weight ratio (GRWR) were noted 19.3 kg/m2, 990 g, and 1.9 %, respectively. During the surgical procedure, she had renoportal anastomosis (RPA) due to extensive portal vein thrombosis to provide an efficient portal inflow to the transplanted graft. No complication was observed in the early postoperative period, and the one year follow up passed without any problem. CONCLUSIONS: In LT, for providing efficient portal flow to the graft, the RPAs should be considered as an option in case of extensive splanchnic vein thrombosis and large splenorenal shunt. Ensuring that graft volume is close to the recipient standard liver volume, RPA can be performed safely and effectively in LDLT as an acceptable and life-saving procedure. HIPPOKRATIA 2019, 23(3): 140-142.

Diagnostic Accuracy of Neutrophil/Lymphocyte Ratio, Red Cell Distribution Width and Platelet Distribution Width in Ovarian Torsion.

The main aim of this diagnostic case-control study of 136 patients with ovarian cysts (44 patients with ovarian torsion and 92 controls) was to determine the diagnostic value of haematologic inflammatory markers (neutrophil/lymphocyte ratio [NLR], red cell distribution width [RDW] and platelet distribution width [PDW]) for torsioned ovarian cysts. The presence of a torsioned ovarian cyst was identified by a 1.18-fold increase in the NLR (95%CI: 1.04-1.34, P = 0.009), a 1.22-fold increase in the RDW (95%CI: 1.04-1.43, P = 0.023) and a 1.93-fold increase in the PDW (95%CI: 1.19-3.14, P = 0.007). The NLR was the best predictor of a torsioned ovarian cyst (AUC: 0.74; 95% CI: 0.68-0.83). When an NLR cut-off value of 2.44 was used to determine ovarian torsion, the sensitivity, specificity, + LR and -LR were 70.5%, 70.7%, 2.40 and 0.42, respectively. In conclusion, the NLR may have diagnostic and prognostic value in determining torsioned ovarian cysts.

Does a predialysis education program increase the number of pre-emptive renal transplantations?

OBJECTIVES: Renal transplantation (RT) is the most appropriate form of treatment for end-stage renal disease (ESRD). Pre-emptive RT decreases the rates of delayed graft function and acute rejection episodes, increasing patient and graft survival, while reducing costs and complications associated with dialysis. In this study, we investigated the relationship between a predialysis education program (PDEP) for patients and their relatives and pre-emptive RT. METHODS: We divided 88 live donor kidney transplant recipients into 2 groups: transplantation without education (non-PDEP group; n = 27), and enrollment in an education program before RT (PDEP group n = 61). RESULTS: Five patients in the non-PDEP group underwent pre-emptive transplantation, versus 26 of the PDEP group. The rate of pre-emptive transplantations was significantly higher among the educated (42.62%) versus the noneducated group (18.51%; P < .001). CONCLUSION: PDEP increased the number of pre-emptive kidney transplantations among ESRD patients.