Efficacy of Biphasic Fluid Therapy in Robot-Assisted Kidney Transplantation

Yıl 2023, Cilt: 15 Sayı: 3, 125 - 138, 30.09.2023

Nalan Saygı Emir

https://doi.org/10.54233/endouroloji.20231503-1345663

Bu makale için 29 Eylül 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/endouroloji/issue/87443/1558610

Öz

Objective: Perioperative fluid treatment is among the factors affecting transplant kidney function. In this
study, the efficacy of biphasic fluid treatment on per-operative patient stabilization and allograft kidney
functions were evaluated.
Material and Methods: Data of 65 robotic living releated donor kidney transplantation performed between
2015-2017 were retrospectively analyzed (16/04/2018, Protocol no 2018-07-13). The patients were divided as
preemptive (Group Preemptif: GP, n=27) and non-preemptive group (Group Non-Preemptif: GNP, n=38).
Biphasic fluid treatment was used in all cases (Phase 1 = before-vascular anastomosis 1-3 ml/kg/h and phase
2 = after-vascular anastomosis 10-12 ml/kg/h, respectively). Hemodynamic and biochemical status of the
patients, early and late allograft kidney function were evaluated. Datas were statistically compared within
and between the groups.
Results: Hemodynamic/metabolic stability and diuresis were achieved after vascular anastomosis in all
patients. There was no difference in the total amount of iv fluid given between the groups, except that the
amount of fluid given in phase 1 was significantly less in GP (p<0.05). Pre-operative blood pH and HCO3
values were lower, Na+ and Cl- values were higher in GP(p<0.05). No difference was found in K+ and Ca+2
values at all times and pH values after extubation in both groups. Pre-operative blood urea and creatinine
levels were significantly higher in GP (p<0.05) but all decreased to normal on postoperative 1 and 7 days. In
long-term follow-up, both groups had similar mortality and rejection rates.
Conclusion: Our results support that biphasic fluid treatment is effective to achieve hemodynamic/
metabolic stability and allograft kidney functions in robotic living releated kidney transplantation patients.

Anahtar Kelimeler

Anesthesia, Fluid Therapy, Hemodynamic monitoring, Kidney transplantation, Transplant recipient, Robot-assisted surgery

Robot Yardımlı Böbrek Naklinde Bifazlı Sıvı Tedavisi’nin Etkinliği

Bu makale için 29 Eylül 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/endouroloji/issue/87443/1558610

Öz

Amaç: Perioperatif sıvı tedavisi, nakledilen böbreğin işlevini etkileyen faktörlerden biridir. Bu çalışmada,
perioperatif hasta stabilizasyonu ve allograft böbrek fonksiyonları üzerine ikili fazlı sıvı tedavisinin etkinliği
değerlendirilmiştir.
Gereç ve Yöntemler: 2015-2017 yılları arasında gerçekleştirilen 65 canlı vericili robot yardımlı laparoskopik
böbrek nakli operasyonu verileri retrospektif olarak analiz edildi (16/04/2018, Protokol no 2018-07-13).
Hastalar nakil öncesi diyaliz tedavisi alan grup (Grup Preemptif: GP, n=27) ve nakil öncesi diyaliz tedavisi
almayan grup (Grup Non-Preemptif: GNP, n=38) olarak bölündü. Tüm vakalarda ikili fazlı sıvı tedavisi kullanıldı
(faz 1=vasküler anastomoz öncesi 1-3 ml/kg/s ve faz 2=vasküler anastomoz sonrası 10-12 ml/kg/s). Hastaların
hemodinamik ve biyokimyasal durumu, erken ve geç allograft böbrek fonksiyonları değerlendirildi. Veriler
istatistiksel olarak gruplar içinde ve arasında karşılaştırıldı.
Bulgular: Tüm hastalarda vasküler anastomoz sonrasında hemodinamik/metabolik stabilite ve diürez elde
edildi. Gruplar arasında intravenöz (iv) sıvı toplam miktarında (faz 1’de verilen miktar dışında) fark yoktu,
ancak GP’de faz 1’ de verilen sıvı miktarı anlamlı olarak daha azdı (p<0,05). Ameliyat öncesi kan pH ve HCO3
değerleri GP’de düşüktü, Na+ ve Cl- değerleri yüksekti (p<0,05). K+ ve Ca+2 değerlerinde her zaman ve
her iki grupta ekstübasyon sonrası pH değerlerinde fark bulunmadı. Ameliyat öncesi kan üre ve kreatinin
düzeyleri GP’de anlamlı olarak yüksekti (p<0,05), ancak tüm değerler ameliyat sonrası 1. ve 7. günlerde
normale döndü. Uzun süreli takipte, her iki grupta da benzer mortalite ve reddetme oranları görüldü.
Sonuç: Sonuçlarımız, canlı vericili robot yardımlı laparoskopik böbrek nakli hastalarında ikili fazlı sıvı
tedavisinin hemodinamik/metabolik stabilite ve allograft böbrek fonksiyonlarını elde etmede etkili
olduğunu desteklemektedir.

Anahtar Kelimeler

Anestezi, Sıvı tedavisi, Hemodinamik izleme, Böbrek nakli, Nakil alıcısı, Robot yardımlı cerrahi

Etik Beyan

Bakirkoy Dr. Sadi Konuk Training and Research Hospital Clinical Studies Ethics Committee Decision Form 13.07.2018218/60

Kaynakça

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