Role of Renal Venous Oxygen Pressure for Renal Function Monitoring After Related Living-Donor Kidney Transplantation: Cohort Study.

BACKGROUND: Monitoring of renal function after kidney transplantation (KT) is performed by measuring serum creatinine (SCr), urine volumes (UV), and glomerular filtration rate (GFR). Other methods based on oxygen metabolism, such as the renal venous oxygen pressure (PrvO2), may be useful. The aim of this study was to explore the correlation between PrvO2 and SCr, UV, and GFR 5 days after KT (SCr5, UV5, and GFR5, respectively). METHODS: We conducted a prospective cohort study in adults scheduled for living donor KT. A venous blood sample was taken from the renal vein after declamping the renal artery, and blood gas determinations were made. Correlation analyses between PrvO2 and SCr5, UV5, and GFR5 were done by calculating Spearman's correlation coefficient with generalized linear models (GLM). A Spearman's correlation analysis was performed between the percentage decrease in SCr (%ΔSCr) and PrvO2. A GLM was also performed to determine the association of PrvO2 with slow graft function (SGF). RESULTS: The study included 42 patients, of whom 67% were men. The median age was 31 years (IQR, 27-43.5). PrvO2 was negatively correlated with SCr5 (ρ = -0.53, P = .003), and positively correlated with GFR5 (ρ = 0.49, P = .001) and %ΔSCr (ρ = 0.47, P = .002). A higher PrvO2 was associated with an increase in GFR in univariable (ß = 1.24, 95% CI, 0.56-1.93, P = .001) and multivariable (ß = 1.24, 95% CI, 0.53-1.94, P = .001) analyses. No association was found between PrvO2 and SGF. CONCLUSION: PrvO2 could be used to monitor renal function in the first 5 days after related living-donor KT, given its good correlation with SCr and GFR.

Evaluation of Renal Function at 24, 48, and 72 Hours and 3 Months After Transplant: Comparison of 3 Anesthetic Techniques.

BACKGROUND: General anesthesia is the conventional management of renal transplant, and its evolution has revolved around the development of new drugs; however, a group of patients meet conditions for neuraxial anesthesia, because of their comorbidities, who are at greater risk of complications with general anesthesia and are not favorable to grafting. METHODS: We conducted a controlled clinical trial of 109 renal transplant recipients where renal function was evaluated at 24, 48, and 72 hours and 3 months after transplant, and we compared regional, general anesthesia with inhaled anesthetic and total intravenous anesthesia. It was performed for 1 year, and serum creatinine, urea nitrogen, and electrolytes were evaluated. During the intraoperative period central venous pressure, mean arterial pressure, vasopressors, fluid therapy, diuretics, surgical time, anesthesia, hot and cold ischemia, immunosuppressants, and antihypertensives were evaluated. They were analyzed with χ2 independence and 1-way and 2-way repeated measures. RESULTS: The type of anesthesia was associated with hemodynamic stability (P = .018), the use of vasopressor (P = .005), and fluid therapy (P = .011). A value of P = .005 was found for central venous pressure at discharge from the operating room, and preincisional mean arterial pressure (P = .015) was among the types of anesthesia. Creatinine, blood urea nitrogen, sodium, and potassium were statistically significant over time (P < .001) but showed no difference between types of anesthesia. CONCLUSION: There is no difference between anesthetic techniques and clinical results over time. The personalized anesthetic technique will improve the neuroendocrine response and surgical stress, decrease the need for vasopressors and analgesics, and reduce complications.

Change in the Pattern of Posttransplantation Anemia in Kidney Receptors: Sex Role in Recipients and Type of Donor.

OBJECTIVE: Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT). MATERIAL AND METHODS: Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χ2 test or Student t test. Significance level was set at P < .05. RESULTS: The mean Hb (standard deviation) before KT was 10.38 (2.16) g/dL; Hb at 12 months was 14.47 (2.37) g/dL with an absolute increase of 4.09 g/dL. Before KT, male kidney recipients had a mean Hb of 10.54 (2.17) g/dL. At 12 months post-KT, mean Hb was 15.33 (2.25) with a change of 4.79 g/dL. Before KT, female kidney recipients had a mean Hb of 10.16 (2.13) g/dL. At 12 months post-KT, mean Hb was 13.31 (2.01) with a change of 3.15 g/dL. The difference between both sexes was 1.64 g/dL at the end of 12 months. Sixteen out of 152 (10.5%) patients had a serum creatinine (Cr) < 1.2 mg/dL and anemia; 36 out of 176 (20.5%) patients had a Cr ≥ 1.2 mg/dL and anemia (P = .014). In the bivariate logistic regression with an odds ratio of 2.047 (95% confidence interval, 1027-4078; P = .042) for higher Cr levels and the presence of persistent anemia. CONCLUSIONS: There is a prevalence of anemia in female kidney recipients and recipients of kidneys from deceased donors. There is a higher risk of persistent anemia in the case of patients with some degree of graft failure at 12 months.

[Modification of health-related quality of life in kidney transplant recipients]. / Modificación de la calidad de vida relacionada con la salud en receptores de trasplante renal.

INTRODUCTION: The assessment of health-related quality of life is essential to renal replacement therapies. We conducted a study to evaluate the change in quality of life at 6 and 12 months after renal transplantation and compared with healthy population and general population. METHODS: A prospective study in 278 renal transplant recipients using the SF-36 survey at 0, 6 and 12 months after transplantation. The results were compared with those obtained in healthy population (kidney donors) and general population. Student t test was employed for comparisons of means. A value of p<0.05 was considered statistically significant. RESULTS: The quality of life before transplantation was lower than that observed in healthy population and the general population (p<0.001). At 6 months of transplantation significant improvement over the baseline measurement (p<0.001) in the 8 domains and the two composite scales was obtained, but at 12 months, an additional benefit was not observed. The quality of life of recipients at 12 months of transplant was lower only in the concept of general health (p=0.035) compared with healthy population. However, it was higher than general population in physical and mental composite scales (p=0.013 and p=0.001 respectively). CONCLUSIONS: The health related quality of life improved significantly at 6 and 12 months after renal transplantation, achieving equated healthy population and general population.

Introducción: la evaluación de la calidad de vida relacionada con la salud es fundamental en las terapias de reemplazo renal. Realizamos un estudio para evaluar la modificación en la calidad de vida a los 6 y 12 meses del trasplante renal y compararla con población sana y población general. Métodos: se realizó un estudio prospectivo en 278 receptores renales aplicando la encuesta SF-36 a los 0, 6 y 12 meses del trasplante. Los resultados fueron comparados con los obtenidos en población sana (donantes renales) y población general. Se empleó prueba t de student para realizar las comparaciones de medias. Una p < 0.05 fue considerada estadísticamente significativa.Resultados: la calidad de vida previa al trasplante fue inferior a la observada en población sana y población general (p < 0.001). A los 6 meses de trasplante se obtuvo mejoría significativa con respecto a la medición basal (p < 0.001) en los 8 dominios y las dos escalas compuestas, pero a los 12 meses no se observó un beneficio adicional. La calidad de vida de los receptores a los 12 meses de trasplante fue inferior solo en el concepto de salud general (p = 0.035) al compararse con la población sana. No obstante, fue superior a la población general en las escalas compuestas física y mental (p = 0.013 y p = 0.001 respectivamente).Conclusiones: la calidad de vida relacionada con la salud mejora significativamente a los 6 y 12 meses del trasplante renal, logrando equipararse con población sana y población general.