1
|
Qureshi MA, Maierean S, Crabtree JH, Clarke A, Armstrong S, Fissell R, Jain AK, Jassal SV, Hu SL, Kennealey P, Liebman S, McCormick B, Momciu B, Pauly RP, Pellegrino B, Perl J, Pirkle JL, Plumb TJ, Seshasai R, Shah A, Shah N, Shen J, Singh G, Tennankore K, Uribarri J, Vasilevsky M, Yang R, Quinn RR, Nadler A, Oliver MJ. The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications. Clin J Am Soc Nephrol 2024; 19:472-482. [PMID: 38190176 PMCID: PMC11020425 DOI: 10.2215/cjn.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications. METHODS Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions observed during catheter insertion. The primary outcome was the composite of PD never starting, termination of PD, or the need for an invasive procedure caused by flow restriction or abdominal pain. RESULTS Seven hundred and fifty-eight individuals were enrolled, of whom 201 (27%) had adhesions during laparoscopic PD catheter insertion. The risk of the primary outcome occurred in 35 (17%) in the adhesion group compared with 58 (10%) in the no adhesion group (adjusted HR, 1.64; 95% confidence interval [CI], 1.05 to 2.55) within 6 months of insertion. Lower abdominal or pelvic adhesions had an adjusted HR of 1.80 (95% CI, 1.09 to 2.98) compared with the no adhesion group. Invasive procedures were required in 26 (13%) and 47 (8%) of the adhesion and no adhesion groups, respectively (unadjusted HR, 1.60: 95% CI, 1.04 to 2.47) within 6 months of insertion. The adjusted odds ratio for adhesions for women was 1.65 (95% CI, 1.12 to 2.41), for body mass index per 5 kg/m 2 was 1.16 (95% CI, 1.003 to 1.34), and for prior abdominal surgery was 8.34 (95% CI, 5.5 to 12.34). Common abnormalities found during invasive procedures included PD catheter tip migration, occlusion of the lumen with fibrin, omental wrapping, adherence to the bowel, and the development of new adhesions. CONCLUSIONS People with intra-abdominal adhesions undergoing PD catheter insertion were at higher risk for abdominal pain or flow restriction preventing PD from starting, PD termination, or requiring an invasive procedure. However, most patients, with or without adhesions, did not experience complications, and most complications did not lead to the termination of PD therapy.
Collapse
Affiliation(s)
- Mohammad Azfar Qureshi
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Serban Maierean
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John H. Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Alix Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean Armstrong
- College of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Fissell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arsh K. Jain
- Department of Medicine, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sarbjit V. Jassal
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susie L. Hu
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter Kennealey
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Scott Liebman
- Department of Medicine, Division of Nephrology, University of Rochester, Rochester, New York
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bogdan Momciu
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Robert P. Pauly
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Beth Pellegrino
- Division of Nephrology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Jeffrey Perl
- Division of Nephrology, Division of Nephrology St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James L. Pirkle
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Troy J. Plumb
- Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rebecca Seshasai
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankur Shah
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nikhil Shah
- Faculty of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, California
| | | | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Murray Vasilevsky
- Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Yang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert R. Quinn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ashlie Nadler
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J. Oliver
- Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Khan WA, Oliver M, Crabtree JH, Clarke A, Armstrong S, Fox D, Fissell R, Jain AK, Jassal SV, Hu SL, Kennealey P, Liebman S, McCormick B, Momciu B, Pauly RP, Pellegrino B, Perl J, Pirkle JL, Plumb TJ, Ravani P, Seshasai R, Shah A, Shah N, Shen J, Singh G, Tennankore K, Uribarri J, Vasilevsky M, Yang R, Quinn RR. Impact of Prior Abdominal Procedures on Peritoneal Dialysis Catheter Outcomes: Findings From the North American Peritoneal Dialysis Catheter Registry. Am J Kidney Dis 2024:S0272-6386(24)00625-5. [PMID: 38447707 DOI: 10.1053/j.ajkd.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 03/08/2024]
Abstract
RATIONALE & OBJECTIVE A history of prior abdominal procedures may influence the likelihood of referral for peritoneal dialysis (PD) catheter insertion. To guide clinical decision making in this population, this study examined the association between prior abdominal procedures and outcomes in patients undergoing PD catheter insertion. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Adults undergoing their first PD catheter insertion between November 1, 2011 and November 1, 2020, at 11 institutions in Canada and the US participating in the International Society for Peritoneal Dialysis (ISPD) North American Catheter Registry. EXPOSURE Prior abdominal procedure(s), defined as any procedure that enters the peritoneal cavity. OUTCOMES Primary outcome: time to the first of abandonment of the PD catheter, or interruption/termination of PD. SECONDARY OUTCOMES rates of emergency room visits, hospitalizations, and procedures. ANALYTICAL APPROACH Cumulative incidence curves were used to describe the risk over time and an adjusted Cox proportional hazards model was used to estimate the association between the exposure and primary outcome. Models for count data were used to estimate the associations between the exposure and secondary outcomes. RESULTS A total of 855 patients met the inclusion criteria. Thirty-one percent had a history of a prior abdominal procedure and 20% experienced at least one PD catheter-related complication that led to the primary outcome. Prior abdominal procedures were not associated with an increased risk of the primary outcome [Adjusted HR 1.12 (95% CI 0.68-1.84)]. Upper abdominal procedures were associated with a higher adjusted hazard of the primary outcome, but there was no dose-response relationship concerning the number of procedures. There was no association between prior abdominal procedures and other secondary outcomes. LIMITATIONS Observational study and cohort limited to sample of patients felt to be potential candidates for PD catheter insertion. CONCLUSION A history of prior abdominal procedure(s) does not appear to influence catheter outcomes following PD catheter insertion. Such a history should not be a contraindication to peritoneal dialysis.
Collapse
Affiliation(s)
- Wazaira A Khan
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Matthew Oliver
- Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - John H Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Alix Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Sean Armstrong
- College of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Danielle Fox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Fissell
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arsh K Jain
- Department of Medicine, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sarbjit V Jassal
- Division of Nephrology, University Health Network, Toronto, Canada and University of Toronto, Toronto, Canada
| | - Susie L Hu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peter Kennealey
- University of Colorado, School of Medicine, Denver, Colorado, USA
| | - Scott Liebman
- Department of Medicine, Division of Nephrology, University of Rochester, Rochester, New York, USA
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bogdan Momciu
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Robert P Pauly
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Beth Pellegrino
- Division of Nephrology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Jeffrey Perl
- Division of Nephrology St. Michael's Hospital, Department of Medicine, Division of Nephrology, University of Toronto, Canada
| | - James L Pirkle
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Troy J Plumb
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Pietro Ravani
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Seshasai
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ankur Shah
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nikhil Shah
- Faculty of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Gurmukteshwar Singh
- Kidney Health Research Institute, Geisinger Health, Danville, Pennsylvania, USA
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University and Nova Scotia, Health, Halifax, Nova Scotia, Canada
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Robert Yang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert R Quinn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
3
|
Kukreja N, Rodriguez IE, Moore HB, LaRiviere W, Crouch C, Stewart E, Nydam TL, Kennealey P, Hendrickse AD, Pomfret EA, Fernandez-Bustamante A. The in-vitro influence of urea concentration on thromboelastrography in patients with and without end stage renal disease. Am J Surg 2023; 226:817-822. [PMID: 37407391 PMCID: PMC10733546 DOI: 10.1016/j.amjsurg.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND End stage renal disease (ESRD) is associated with platelet dysfunction but also thromboembolic complications. The specific role of increased blood urea nitrogen (BUN) on coagulation is unclear. We aimed to characterize thromboelastography (TEG) parameters from males and females with ESRD and normal kidney function and evaluate if exogenous urea in vitro reproduced those TEG differences. METHODS We collected blood samples from 20 living kidney donors and 20 kidney recipients. TEG was performed without and with two increasing urea concentrations in vitro. TEG parameters were compared between recipients and donors. RESULTS Blood from kidney recipients showed baseline increased maximum amplitude (MA) and shortened time to maximum amplitude (TMA) compared to donors. These differences were not confirmed in females. In all patients, BUN was inversely correlated with TMA (r = -0.342; p = 0.031). In males, BUN and creatinine concentrations showed a direct correlation with MA (0.583; p = 0.007) and an inverse correlation with TMA (r = -0.520; p = 0.019). Urea in vitro decreased R-time (p = 0.005) and increased LY30 (p = 0.009) in donors but not recipients. CONCLUSIONS ESRD is associated with increased MA and decreased TMA on TEG. No change in MA was observed with increasing urea concentrations in vitro. Gender-specific variability in TEG parameters were observed.
Collapse
Affiliation(s)
- Naveen Kukreja
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ivan E Rodriguez
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hunter B Moore
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cara Crouch
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erin Stewart
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Trevor L Nydam
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peter Kennealey
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adrian D Hendrickse
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth A Pomfret
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | |
Collapse
|
4
|
Atwater RC, Kennealey P, Nydam TL, Pomfret EA, Moore HB. Postoperative Thrombotic Complications in Kidney Transplant Recipients: A Selective High-Risk Cohort. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Choudhury RA, Yoeli D, Nydam TL, Kennealey P. Pancreas Transplant in Chronic Kidney Disease for Type 1 Diabetic Patients. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Walker CB, Moore HB, Nydam TL, Schulick AC, Yaffe H, Pomposelli JJ, Wachs M, Bak T, Conzen K, Adams M, Pshak T, Choudhury R, Chapman MP, Pomfret EA, Kennealey P. The use of thromboelastography to assess post-operative changes in coagulation and predict graft function in renal transplantation. Am J Surg 2020; 220:1511-1517. [PMID: 32878689 PMCID: PMC7450953 DOI: 10.1016/j.amjsurg.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/28/2020] [Accepted: 08/19/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND End stage renal disease (ESRD) is associated with elevated fibrinogen levels and fibrinolysis inhibition. However, there is a paucity of data on how renal transplantation impacts coagulation. we hypothesize that renal transplantation recipients with good functioning grafts will have improved fibrinolytic activity following surgery. METHODS Kidney recipients were analyzed pre-operatively and on post-operative day 1(POD1) using three different TEG assays with and without two concentration of tissue-plasminogen activator (t-PA). TEG indices and percent reduction in creatinine from pre-op to POD1 were measured, with >50% defining "good" graft function. Follow up was done at 6, 12, and 24 months. RESULTS Percent lysis(LY30) on POD1 the t-PA TEG was significantly correlated to change creatinine from pre-op to POD-1(p = 0.006). A LY30 ≥ 23% was associated with good early graft function, and lower creatinine at 24-months(p = 0.028) compared to recipients with low POD1 LY30. CONCLUSIONS Post-operative tPA-TEG LY30 is associated with favorable early and late outcomes in kidney transplant.
Collapse
Affiliation(s)
- Carson B Walker
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA.
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Alexander C Schulick
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Hillary Yaffe
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - James J Pomposelli
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Michael Wachs
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Thomas Bak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Kendra Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Megan Adams
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Thomas Pshak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Rashikh Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Michael P Chapman
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Elizabeth A Pomfret
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Peter Kennealey
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| |
Collapse
|
7
|
Schulick AC, Moore HB, Walker CB, Yaffe H, Pomposelli JJ, Azam F, Wachs M, Bak T, Kennealey P, Conzen K, Adams M, Pshak T, Choudhury R, Chapman MP, Pomfret EA, Nydam TL. A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation. Am J Surg 2020; 220:1379-1386. [PMID: 32907709 DOI: 10.1016/j.amjsurg.2020.07.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/14/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND An NIH clinical coagulopathy score has been devised for trauma patients, but no such clinical score exists in transplantation surgery. We hypothesize that that this coagulopathy score can effectively identify laboratory defined coagulopathy during liver transplantation and correlates to blood product utilization. METHODS TEGs were performed and coagulopathy scores (1, normal bleeding - 5, diffuse coagulopathic bleeding) were assigned by the surgeons at 5 intra-operative time points. Blood products used during the case were recorded between time points. Statistical analyses were performed to identify correlations between coagulopathy scores, TEG-detected abnormalities, and blood product utilization. RESULT Transfusions rarely correlated with the appropriate TEG measurements of coagulation dysfunction. Coagulopathy score had significant correlation to various transfusions and TEG-detected coagulopathies at multiple points during the case. High aggregate coagulopathy scores identified patients receiving more transfusions, re-operations, and longer hospital stays CONCLUSION: The combination of viscoelastic testing and a standardized clinical coagulopathy score has the potential to optimize transfusions if used in tandem as well as standardize communication between surgery and anesthesia teams about clinically evident coagulopathy.
Collapse
Affiliation(s)
- Alexander C Schulick
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States.
| | - Carson B Walker
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Hillary Yaffe
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - James J Pomposelli
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Fareed Azam
- Department of Anesthesiology, University of Colorado, United States
| | - Michael Wachs
- Department of Surgery, Childrens Hospital Colorado, United States
| | - Thomas Bak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Peter Kennealey
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Kendra Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Megan Adams
- Department of Surgery, Childrens Hospital Colorado, United States
| | - Thomas Pshak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Rashikh Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Michael P Chapman
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Elizabeth A Pomfret
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado, United States
| |
Collapse
|
8
|
Moore HB, Yaffe H, Pomposelli JJ, Wachs M, Bak T, Kennealey P, Conzen K, Adams M, Pshak T, Choudhury R, Walker C, Schulick A, Ferrell T, Chapman MP, Pomfret EA, Nydam TL. Detection of early allograft dysfunction at 30 min of reperfusion in liver transplantation: An intraoperative diagnostic tool with real time assessment of graft function. Am J Surg 2020; 220:1518-1525. [PMID: 32907708 DOI: 10.1016/j.amjsurg.2020.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/30/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION During the anhepatic phase of liver transplantation (LT), fibrinolytic activity increases, since the liver clears tissue plasminogen activator (tPA). We hypothesize that patients who fail to reduce fibrinolytic activity following graft reperfusion will have an increased rate of early allograft dysfunction (EAD). METHODS Assessment of fibrinolysis in liver transplant recipients was quantified with thrombelastography (TEG) LY30. Changes in LY30 were assessed after graft reperfusion. The 30-min post-reperfusion LY30 was subtracted from the anhepatic LY30 quantifying fibrinolytic changes (delta-LY30). RESULTS Seventy-three primary LT patients were included in the analysis. Receiver operating characteristic curve (ROC) analysis identified an inflection point of delta-LY30-5.3% as a risk factor for EAD. EAD occurred in 44% of these patients compared to 5% in high delta-LY30 (p = 0.002). CONCLUSION LT recipients that develop hyperfibrinolysis who fail to reduce fibrinolytic activity 30 min after graft reperfusion had an EAD rate 8-fold higher than patients who had a large reduction in LY30 following reperfusion.
Collapse
Affiliation(s)
- Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA.
| | - Hillary Yaffe
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - James J Pomposelli
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Michael Wachs
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Thomas Bak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Peter Kennealey
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Kendra Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Megan Adams
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Thomas Pshak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Rashikh Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Carson Walker
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Alexander Schulick
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Tanner Ferrell
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Michael P Chapman
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Elizabeth A Pomfret
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO, USA
| |
Collapse
|
9
|
Flechner SM, Cooper M, Waterman A, Kennealey P, Redfield R, Verbesey J. Ethical principles governing organ transplantation apply to paired exchange programs. Am J Transplant 2020; 20:1756-1757. [PMID: 32277552 DOI: 10.1111/ajt.15906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Stuart M Flechner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | - Amy Waterman
- Division of Nephrology, UCLA School of Medicine, Los Angeles, California, USA
| | - Peter Kennealey
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, California, USA
| | - Robert Redfield
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Jennifer Verbesey
- Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA
| |
Collapse
|
10
|
Saidi RF, Bradley J, Greer D, Luskin R, O'Connor K, Delmonico F, Kennealey P, Pathan F, Schuetz C, Elias N, Ko DSC, Kawai T, Hertl M, Cosimi AB, Markmann JF. Changing pattern of organ donation at a single center: are potential brain dead donors being lost to donation after cardiac death? Am J Transplant 2010; 10:2536-40. [PMID: 21043059 DOI: 10.1111/j.1600-6143.2010.03215.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donation after cardiac death (DCD) has proven effective at increasing the availability of organs for transplantation.We performed a retrospective examination of Massachusetts General Hospital (MGH) records of all 201 donors from 1/1/98 to the 11/2008, including 54 DCD, 115 DBD and 32 DCD candidates that did not progress to donation (DCD-dnp). Comparing three time periods, era 1 (01/98-12/02), era 2 (01/03-12/05) and era 3 (01/06-11/08), DCD’s comprised 14.8,48.4% and 60% of donors, respectively (p = 0.002). A significant increase in the incidence of cardiovascular/cerebrovascular as cause of death was evident in era 3 versus eras 1 and 2; 74% versus 57.1% (p<0.001),as was a corresponding decrease in the incidence of traumatic death. Interestingly, we noted an increase in utilization of aggressive neurological management over time, especially in the DCD group.We detected significant changes in the make-up of the donor pool over the past decade. That the changes in diagnosis over time did not differ between DCD and DBD groups suggests this difference is not responsible for the increase in DCD rates. Instead, we suggest that changes in clinical practice, especially in management of patients with severe brain injury may account for the increased proportion of DCD.
Collapse
Affiliation(s)
- R F Saidi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Agorastou P, Tsoulfas G, Ko D, Hertl M, Elias N, Saidi R, Kennealey P, Markmann J, Kawai T. Lessons Learned in the First Decade of a Laparoscopic Living Donor Nephrectomy Program. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
12
|
Saidi RF, Wertheim JA, Kennealey P, Ko DSC, Elias N, Yeh H, Hertl M, Kawai T. Donor kidney recovery methods and the incidence of lymphatic complications in kidney transplant recipients. Int J Organ Transplant Med 2010; 1:40-3. [PMID: 25013562 PMCID: PMC4089215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 06/04/2009] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Lymphatic leak and lymphocele are well-known complications after kidney transplantation. OBJECTIVE To determine the incidence of lymphatic complications in recipients of living donor kidneys. METHODS Among 642 kidney transplants performed between 1999 and 2007, the incidence of lymphatic complications was retrospectively analyzed in recipients of living donor kidneys procured by laparoscopic nephrectomy (LP, n=218) or by open nephrectomy (OP, n=127) and deceased donor kidneys (DD, n=297). A Jackson-Pratt drain was placed in the retroperitoneal space in all recipients and was maintained until the output became less than 30 mL/day. RESULTS Although the incidence of symptomatic lymphocele, which required therapeutic intervention, was comparable in all groups, the duration of mean±SD drain placement was significantly longer in the LP group-8.6±2.7 days compared to 5.6±1.2 days in the OP group and 5.4±0.7 days in the DD group (p<0.001). Higher output of lymphatic drainage in recipients of LP kidneys could lead to a higher incidence of lymphocele if wound drainage is not provided. CONCLUSION More meticulous back table preparation may be required in LP kidneys to decrease lymphatic complications after kidney transplantation. These observations also support the suggestion that the major source of persistent lymphatic drainage following renal transplantation is severed lymphatics of the allograft rather than those of the recipient's iliac space.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - T. Kawai
- Correspondence: Tatsuo Kawai, MD, PhD, WHT 510 Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02214,
Phone: +1-617-726-0289, Fax: +1-617-726-9322
E-mail:
| |
Collapse
|