martes, 9 de mayo de 2017

Donador vivo renal / Live kidney donor

Mayo 9 2017. No. 2684







Función renal de donadores vivos programados para nefrectomía con sevorano o desflurano
Kidney function in living donors undergoing nephrectomy by sevoflurane or desflurane anesthesia.
Yonsei Med J. 2013 Sep;54(5):1266-72. doi: 10.3349/ymj.2013.54.5.1266.
Abstract
PURPOSE: Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia. MATERIALS AND METHODS: From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR). RESULTS: The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR. CONCLUSION: Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.
KEYWORDS: Desflurane; living donors; nephrectomy; sevoflurane

¿Podría el uso de un protocolo de recuperación mejorado en la nefrectomía del donante laparoscópico ser un incentivo para el donador vivo?
Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy be an Incentive for Live Kidney Donation?
Cureus. 2016 Nov 22;8(11):e889. doi: 10.7759/cureus.889.
Abstract
INTRODUCTION AND BACKGROUND: Gastrointestinal (GI) recovery after major abdominal surgery can be delayed from an ongoing need for narcotic analgesia thereby prolonging hospitalization. Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to facilitate early recovery after major surgery by maintaining preoperative body composition and physiological organ function and modifying the stress response induced by surgical exposure. Enhanced recovery programs (ERPs) in colorectal surgery have decreased the duration of postoperative ileus and the hospital stay while showing equivalent morbidity, mortality, and readmission rates in comparison to the traditional standard of care. This study is a pilot trial to evaluate the benefits of ERAS protocols in living kidney donors undergoing laparoscopic nephrectomy. METHODS: This is a single-center, non-randomized, retrospective analysis comparing the outcomes of the first 40 live kidney donors subjected to laparoscopic nephrectomy under the ERAS protocol to 40 donors operated prior to ERAS with traditional standard of care. Our ERAS protocol includes reduced duration of fasting with preoperative carbohydrate loading, intraoperative fluid restriction to 3 ml/kg/hr, target urine output of 0.5 ml/kg/hr, use of subfascial Exparel injection (bupivacaine liposome suspension), and postoperative narcotic-free pain regimen with acetaminophen, ketorolac, or tramadol. Short-term patient outcomes were compared using Pearsons's Chi-Squared test for categorical variables and the Kruskal-Wallis test for continuous variables. Additionally, a multivariate analysis was conducted to evaluate factors influencing patient length of stay and likelihood of readmission. RESULTS: ERAS protocol reduced the postoperative median length of stay decreased from 2.0 to 1.0 days (p=0.001). Overall pain scores were significantly lower in the ERAS group (peak pain score 6.0 vs. 8.00, p< 0.001; morning after surgery pain score 3.0 vs. 7.0, p=0.001; lowest pain score 0.0 vs. 2.0, p=0.016) despite the absence of postoperative narcotics. The average duration of surgery was shorter in the ERAS group (248 vs. 304 minutes, p<0.001). The average amount of intraoperative fluid used was significantly lower in the ERAS group (2500 ml vs. 3525 ml, p<0.001) without affecting the donor renal function. The incidence of delayed graft function was similar in the two groups (p=0.541). A trend toward lower readmission was noted with the ERAS protocol (12.8% vs. 27.5%, p=0.105). GI dysfunction was the most common reason for readmission. CONCLUSION:
Application of an ERAS protocol in a laparoscopic living donor nephrectomy was associated with reduced length of hospitalization and improved pain scores related likely to intraoperative use of subfascial Exparel and a shorter duration of ileus. Restricted use of intraoperative fluids prevents excessive third spacing and bowel edema, enhancing gut recovery without adversely impacting recipient graft function. This study suggests that ERAS has the potential to enhance the advantages of laparoscopic surgery for live kidney donation through optimizing donor outcomes and perioperative patient satisfaction.
KEYWORDS: donor readmission rates; enhanced recovery after surgery (eras); enhanced recovery programs (erps); laparoscopic living donor nephrectomy; length of stay (los); postoperative pain scores

El estudio del donador vivo para trasplante renal
Carlos Arroyo,* Fernando Gabilondo,* Bernardo Gabilondo*
Rev. invest. clín. vol.57 no.2 México mar./abr. 2005
Resumen
Actualmente, por la falta de órganos para trasplante renal provenientes de cadáveres, y debido al largo tiempo de espera por un riñón, existe una tendencia a realizar trasplantes renales utilizando riñones procedentes de donadores vivos. La mayoría de los donadores son familiares del receptor. La donación de órganos debe considerarse como un regalo con un valor extraordinario y debe facilitarse a los candidatos a donación. En todo el mundo se ha observado un aumento en el número de personas en la lista de espera para un trasplante renal. El trasplante renal de donador vivo se considera actualmente como el mejor método de tratamiento en pacientes con insuficiencia renal terminal, debido a que ofrece la mayor supervivencia a corto y largo plazos. En vista de que existen diferencias significativas en los criterios de selección y evaluación de donadores renales, en especial en un grupo selecto de pacientes añosos o con enfermedades asociadas, es indispensable establecer criterios mínimos de selección. Todos los donadores deberán contar con una historia clínica completa y exámenes de laboratorio y gabinete que permitan su evaluación integral. Estos estudios se describen con detalle en este artículo. También se discuten los criterios para donadores renales con ciertas comorbilidades (obesos, hipertensos, hiperglucémicos, con litiasis y neoplasias) que previamente se descartaban como candidatos para donación.
Palabras clave. Donador renal. Trasplante renal. Donador vivo renal.

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