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1.
Am J Transplant ; 18(8): 1966-1976, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29380523

RESUMO

Insufficient hemodynamics during agonal phase-ie, the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2 > 60% or SpO2 < 60%, and minutes of SBP > 80 mmHg or SBP < 80 mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at three years was 76%. Longer periods of agonal phase (median 16 min [IQR 11-23]) contributed significantly to an increased risk of DGF (P = .012), but not to PNF (P = .071) and graft failure (P = .528). Multiple logistic regression analysis showed that an increase from 7 to 20 minutes in period of SBP < 80 mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P = .030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP < 80 mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2 < 60% does.


Assuntos
Função Retardada do Enxerto/mortalidade , Rejeição de Enxerto/mortalidade , Hemodinâmica , Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/métodos , Adulto , Pressão Sanguínea , Morte , Função Retardada do Enxerto/etiologia , Seleção do Doador , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Perfusão , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Sístole
2.
Transfus Med ; 15(1): 13-8, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15713124

RESUMO

Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6-8-10-Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case-control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1.1 +/- 1.5 to 0.6 +/- 1.2 and 0.3 +/- 0.9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 +/- 1.5, 1 +/- 1.7 and 1 +/- 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused.


Assuntos
Artroplastia de Quadril , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue Autóloga , Transfusão de Eritrócitos , Guias de Prática Clínica como Assunto , Idoso , Artroplastia de Quadril/normas , Transfusão de Sangue Autóloga/normas , Procedimentos Cirúrgicos Eletivos/normas , Transfusão de Eritrócitos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto/normas
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