Dataset Information

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy.

ABSTRACT:

Background

To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAP_d) and non-donor kidneys (MAP_nd) with post-donation renal function.

Methods

Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAP_d and MAP_nd were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively.

Results

Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m² (range 17.1-39.6) and median age 45 years (range 19-78). MAP_d score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAP_nd score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/1.73m² (range 48.8-138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAP_nd = 0, donors with a MAP_nd > 0, mean eGFR was - 2.33 ml/min/1.73m² lower at postoperative day 1 (95% CI - 4.24 to - 0.41, p = 0.018), - 3.02 ml/min/1.73m² lower at 1 month (95% CI - 5.11 to - 0.93, p = 0.005), and - 2.63 ml/min/1.73m² lower at 6 months postoperatively (95% CI - 5.01 to - 0.26, p = 0.030).

Conclusions

MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.

SUBMITTER: Cockerill KJ

PROVIDER: S-EPMC7433049 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy.

Cockerill Katherine J KJ Kahn Amanda E AE Young Stacy M SM Ball Colleen T CT Mai Martin L ML Taner C Burcin CB Perry Dana K DK Thiel David D DD

BMC urology 20200817 1

<h4>Background</h4>To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAP<sub>d</sub>) and non-donor kidneys (MAP<sub>nd</sub>) with post-donation renal function.<h4>Methods</h4>Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAP<sub>d</sub> and MAP<sub>nd</sub> were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months post ...[more]

PMID: 32807136

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Project description:BACKGROUND:Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon's experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy. METHODS:The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis. RESULTS:The final multivariable model included the following three factors: open operative approach (P?<?0.001), Neves classification IV (P?<?0.001), inferior vena cava resection (P?=?0.001). The PKUTH score (0-3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280?mL (interquartile range [IQR] 100-600?mL), 1250?mL (IQR 575-2700?mL), 2000?mL (IQR 1250-2900?mL), and 5000?mL (IQR 4250-8000?mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P?=?0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0 vs. 1 to 3 (P?=?0.098). CONCLUSION:We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.

Project description:Study objectiveTo assess whether different intensities of intra-abdominal pressure and deep neuromuscular blockade influence the risk of intra-operative surgical complications during laparoscopic donor nephrectomy.DesignA pooled analysis of ten previously performed prospective randomized controlled trials.SettingLaparoscopic donor nephrectomy performed in four academic hospitals in the Netherlands: Radboudumc, Leiden UMC, Erasmus MC Rotterdam, and Amsterdam UMC.PatientsFive hundred fifty-six patients undergoing a transperitoneal, fully laparoscopic donor nephrectomy enrolled in ten prospective, randomized controlled trials conducted in the Netherlands from 2001 to 2017.InterventionsModerate (tetanic count of four > 1) versus deep (post-tetanic count 1-5) neuromuscular blockade and standard (≥10 mmHg) versus low (<10 mmHg) intra-abdominal pressure.MeasurementsThe primary endpoint is the number of intra-operative surgical complications defined as any deviation from the ideal intra-operative course occurring between skin incision and closure with five severity grades, according to ClassIntra. Multiple logistic regression analyses were used to identify predictors of intra- and postoperative complications.Main resultsIn 53/556 (9.5%) patients, an intra-operative complication with ClassIntra grade ≥ 2 occurred. Multiple logistic regression analyses showed standard intra-abdominal pressure (OR 0.318, 95% CI 0.118-0.862; p = 0.024) as a predictor of less intra-operative complications and moderate neuromuscular blockade (OR 3.518, 95% CI 1.244-9.948; p = 0.018) as a predictor of more intra-operative complications. Postoperative complications occurred in 31/556 (6.8%), without significant predictors in multiple logistic regression analyses.ConclusionsOur data indicate that the use of deep neuromuscular blockade could increase safety during laparoscopic donor nephrectomy. Future randomized clinical trials should be performed to confirm this and to pursue whether it also applies to other types of laparoscopic surgery.Trial registrationClinicaltrials.gov LEOPARD-2 (NCT02146417), LEOPARD-3 trial (NCT02602964), and RELAX-1 study (NCT02838134), Klop et al. ( NTR 3096 ), Dols et al. 2014 ( NTR1433 ).

Dataset Information

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy.

Background

Methods

Results

Conclusions

Publications

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy.

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