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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...
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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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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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Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in...
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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Murine Renal Transplantation Procedure
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[Renal transplantation at night].

M Matthijs Fockens1, Victor P Alberts, Frederike J Bemelman

  • 1Academisch Medisch Centrum, Amsterdam.

Nederlands Tijdschrift Voor Geneeskunde
|October 16, 2014
PubMed
Summary

Night-time kidney transplants are safe, showing no increased surgical complications or reduced graft function. Minimizing cold ischaemia time (CIT) is crucial, making immediate transplantation, even at night, a justifiable practice.

Area of Science:

  • Nephrology
  • Transplant Surgery
  • Surgical Outcomes

Background:

  • Prolonged cold ischaemia time (CIT) in renal transplantation correlates with adverse outcomes like delayed graft function, rejection, and graft failure.
  • Renal transplantations are often performed immediately upon organ availability to minimize CIT, frequently necessitating night-time surgeries.
  • Concerns exist regarding potential increased surgical complications associated with night-time versus daytime operations.

Purpose of the Study:

  • To evaluate the impact of night-time renal transplantation on surgical complication rates.
  • To assess the effect of night-time surgery on immediate and short-term graft function.
  • To determine if night-time kidney transplants are a safe alternative to daytime procedures when minimizing CIT is critical.

Main Methods:

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  • Retrospective analysis of 384 adult deceased-donor renal transplantations performed between January 2007 and June 2012.
  • Categorization of transplantations into day-time and night-time (11 PM to 6 AM) groups.
  • Comparison of surgical complication rates (primary outcome) and graft function (secondary outcome) between the two groups.

Main Results:

  • No statistically significant differences were found in the incidence of surgical complications between day-time and night-time renal transplantations.
  • Graft function did not differ significantly between recipients undergoing day-time versus night-time surgery.
  • A statistically significant increase in cold ischaemia time (CIT) was observed in the night-time transplantation group (p < 0.001).

Conclusions:

  • Night-time renal transplantation is a safe procedure, not associated with increased surgical complications or compromised graft function.
  • The practice of performing renal transplants at night to minimize CIT is supported by these findings.
  • Delaying kidney transplantation until morning to avoid night-time surgery is not justified, given the established benefits of reduced CIT.