Risk Factors for Graft Loss Due to Acute Vascular Complications in Adult Renal Transplantation Using Grafts Without Vascular Anomalies

Adani, Gian Luigi; Pravisani, Riccardo; Baccarani, Umberto; Faion, Matteo; Crestale, Sara; Tulissi, P.; Vallone, C.; Risaliti, Andrea

doi:10.1016/j.transproceed.2019.03.088

Cited by 11 publications

(6 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even in ECD graft cases, the prolongation of CIT with HMP did not significantly worsen the clinical outcome. Overall, the prevalence of KT morbidity in our HMP group was safely within the ranges reported in literature (DGF: 25%-31%, 18,19 vascular complications: 1%-23%, 16 urologic complications: 2.5%-14% 20 ). In terms of financial impact, the prolongation of CIT has been demonstrated not to directly lead to increased transplant-related costs, although some concerns have been risen regarding the indirect cost associated with postoperative complications.…”

Section: Discussionsupporting

confidence: 84%

See 1 more Smart Citation

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

et al. 2021

Self Cite

View full text Add to dashboard Cite

In deceased donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) is a negative prognostic factor for KT outcome, and the efficacy of hypothermic machine perfusion (HMP) in prolonging CIT without any additional hazard is highly debated. We conducted a retrospective study on a cohort of 154 single graft deceased donor KTs, in which a delayed HMP, after a preliminary period of static cold storage (SCS), was used to prolong CIT for logistic reasons. Primary outcomes were postoperative complications as well as 1 year graft survival and function. 73 cases (47.4%) were managed with HMP and planned KT, while 81 (52.6%) with SCS and urgent KT. The median CIT in HMP group and SCS group was 29 hour:57 minutes [27-31 hour:45 minutes] and 11 hour:25 minutes [9-14 hour:30 minutes], respectively (P < .001). The period of SCS in the HMP group was significantly shorter than in the SCS group (10 vs. 11 hour:25 minutes, P = .02) as well as the prevalence of expanded criteria donors was significantly higher (43.8% vs. 18.5%, P < .01). After propensity score matching for these two baseline characteristics, the HMP and SCS groups showed comparable outcomes in terms of delayed graft function, vascular, and urologic complications, infections, and episodes of graft rejection. At 1 year follow-up, serum creatinine levels were comparable between the groups. Therefore, the use of HMP to prolong the CIT and convert KT into a planned procedure seemed to have an adequate safety profile, with outcomes comparable to KT managed as an urgent procedure and a CIT nearly three time shorter. K E Y W O R D Scold ischemia time, delayed graft function, hypothermic machine perfusion, kidney transplant morbidity, kidney transplantation How to cite this article: Adani GL, Pravisani R, Tulissi P, et al. Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function.

show abstract

Section: Discussionsupporting

confidence: 84%

“…Graft loss was considered either in case of graft nephrectomy or return to dialysis due to graft failure. The immunosuppressive protocol, postoperative management and follow‐up surveillance have been already previously described 6,9,16 …”

Section: Methodsmentioning

confidence: 99%

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…3 Noninfective pseudoaneurysms can result from arterial wall injury or suture defects. [4][5][6] These lesions may be asymptomatic or present with kidney dysfunction, pain at transplant site, or lumbar plexopathy due to compression and malignant hypertension. 7 In the case of rupture, it can lead to hemorrhagic shock and death.…”

Section: Discussionmentioning

confidence: 99%

“…17 Third, the patient experienced acute rejection, which is a risk factor for acute vascular complications. 6 Considering the hemodynamic stability and the good quality of the kidney, a plan for graft salvage was made. Surgical option was excluded because of high risk of nephrectomy, bleeding, and hemorrhage shock.…”

Section: Discussionmentioning

confidence: 99%

Anastomotic Pseudoaneurysm in Kidney Transplant: A Challenging Management for a Rare Entity

et al. 2022

View full text Add to dashboard Cite

Purpose: Anastomotic pseudoaneurysms of transplanted kidneys are a very rare complication encountered in less than 1% of cases. They may be devastating, leading to functional impairment, kidney transplantectomy, or death. Treatment has not been standardized, with open surgical repair considered the safest procedure even if it is often complicated by bleeding and graft loss. The purpose of this case report is to describe an endovascular treatment of this condition, consisting of the combination of coil embolization and arterial stenting. Case report: A 61-year-old woman developed an anastomotic pseudoaneurysm 2 months after kidney transplantation, causing acute kidney injury related to ab-extrinsic stenosis of the transplant renal artery (TRA) and external iliac artery. The pseudoaneurysm was successfully treated by coil embolization, and the arterial patency was restored by the stenting of TRA and external iliac artery. The patient completely recovered kidney function, and after a 6-month-follow-up, creatinine values were stable with normal renal perfusion. Conclusion: Endovascular repair through coil embolization and TRA stenting can be a safe and effective option to treat anastomotic pseudoaneurysm in kidney transplant.

show abstract

“…The grafts were kept in HMP until the time of placement into the abdomen with initiation of the warm ischemia time. The details of KT surgical procedure, postoperative management, and follow-up clinical surveillance have already been described elsewhere [12]. A DGF was defined as need for dialysis in the first postoperative week.…”

Section: Surgical Procedures and Postoperative Managementmentioning

confidence: 99%

Effects of Delayed Hypothermic Machine Perfusion on Kidney Grafts with a Preliminary Period of Static Cold Storage and a Total Cold Ischemia Time of Over 24 Hours

et al. 2020

Self Cite

View full text Add to dashboard Cite

Departmental sources Background: Hypothermic machine perfusion (HMP) appears to exert a reconditioning effect on the ischemic damage of kidney grafts. However, some concerns still remain about its real effectiveness when it is delayed after a preliminary period of static cold storage (SCS) or with prolonged overall cold ischemia time (CIT). Material/Methods: The effect of HMP on hemodynamic, metabolic, histological and ultrastructural features of grafts was investigated in 21 single-kidney grafts treated with a delayed HMP after SCS and with a total CIT of over 24 h. Results: The mean CIT, SCS, and HMP times were 29 h, 12 h, and 18 h, respectively. Longer SCS was associated with higher vascular resistance and lower arterial flow. In the pre-vs. post-HMP comparison, a significant decrease in arterial resistances and increase of flow were recorded. The hemodynamic improvement was independent of HMP duration. The perfused grafts retained some metabolic activity, with a statistically significant decrease of pH, pO2, and glucose levels, and increase of lactates in the perfusion liquid, by the end of HMP. Longer SCS was associated with higher pH and greater pO2 decrease during HMP. Light microscopy and transmission electronic microscopy revealed no significant variations in nuclear, cytoplasmic, or ultrastructural damage. SCS, HMP, and CIT were not identified as risk factor for delayed graft function or rejection. Conclusions: A delayed and extended HMP can recover the graft hemodynamic function, maintain some metabolic activity, and stabilize the accumulated ischemic damage due to a preliminary SCS.

show abstract

Risk Factors for Graft Loss Due to Acute Vascular Complications in Adult Renal Transplantation Using Grafts Without Vascular Anomalies

Cited by 11 publications

References 10 publications

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

Anastomotic Pseudoaneurysm in Kidney Transplant: A Challenging Management for a Rare Entity

Effects of Delayed Hypothermic Machine Perfusion on Kidney Grafts with a Preliminary Period of Static Cold Storage and a Total Cold Ischemia Time of Over 24 Hours

Contact Info

Product

Resources

About