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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...

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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
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[Liver transplantation and peri-operative changes to renal function].

E Kieslichová1, O Schück, I Smrcková

  • 1Klinika anesteziologie, resuscitace a intenzivní péce IKEM Praha. evki@ikem.cz

Vnitrni Lekarstvi
|January 15, 2010
PubMed
Summary

Orthotopic liver transplantation (OLT) significantly impacts kidney function, with perioperative proteinuria indicating renal injury. Most patients requiring renal replacement therapy (RRT) early post-transplant recover kidney function within a year.

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Area of Science:

  • Nephrology
  • Hepatology
  • Transplantation Surgery

Context:

  • Orthotopic liver transplantation (OLT) is a complex procedure with significant implications for renal function.
  • Understanding perioperative renal changes is crucial for managing post-transplant outcomes.
  • Acute kidney injury (AKI) is a common complication following OLT.

Purpose:

  • To analyze perioperative renal function changes during OLT.
  • To identify risk factors associated with the need for renal replacement therapy (RRT) in the first week post-OLT.
  • To assess long-term renal function recovery after OLT.

Summary:

  • OLT leads to significant alterations in glomerular and tubular renal functions, evidenced by changes in serum and urine creatinine and urea.
  • Perioperative proteinuria, particularly the urinary protein-to-creatinine ratio (Uprot/Ucr), emerged as a sensitive marker for renal injury during OLT.
  • Risk factors for AKI requiring RRT included higher APACHE scores, BMI, preoperative renal parameters, hepatorenal syndrome, intraoperative instability, and graft dysfunction.

Impact:

  • Early postoperative RRT for AKI following OLT does not preclude long-term renal function recovery.
  • Identifying at-risk patients and monitoring perioperative proteinuria can aid in timely intervention and management.
  • This study provides valuable insights for optimizing patient care and improving outcomes in OLT recipients.