Journal of Advanced Surgical Research

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +1-845-458-6882

Research Article - Journal of Advanced Surgical Research (2021) Volume 5, Issue 1

Revascularization in renal transplant patients - why and when: Our experience.

Background:Ample documentation suggesting Renal Transplant patients undergoing CABG exists, few proved the benefits of revascularization prior to transplantation. Aim: We performed revascularization before transplantation. Methods:Presenting two patients for live donor transplantation, with echocardiographic findings prompting angiography. CABG was planned followed 6 months later by transplantation allowing physical, psychological, emotional recovery. CABG ? Strict B.P and sugar control with Inotropes and insulin. ? Fluid management using TEE. ? BIS between 45-60 ? Off-pump surgery. ? Fast-tracking-extubated within 2 hours. ? Prompt acidosis, potassium and hypothermia correction. ? Dialysis day1 postop. ? Transplant ? Good hemodynamic stability intra and post-op ? Generous intravenous fluids. ? Good urine output, no ma?or cardiovascular events intra,postop,2 years follow-up. Result:Meticulously given anaesthesia, diligent postop management and fine surgical skills helped decrease morbidity and mortality. Renal transplantation offers best outcome for ESRD 37-53%asymptomatic ESRD patients have significant stenosis. 10% have CCF due to dilated cardiomyopathy, hypertrophic hyperkinetic disease, anemia, hyperparathyroidism, diastolic dysfunction. This prompted pre-transplant angiography. Revascularisation followed by transplantation had 98% and 88.4% cardiac event free survival at 1 and 3 years.3.Optimal medical management, in a meta-analysis shows no difference in post-transplant cardiovascular outcomes.5. Revascularization entails dual anti-platelet therapy with bleeding risks. With newer drug-eluting stents dual anti-platelets can be stopped after 3-6months.During transplantation there were 36 events in revascularization group and 57 in Medical management group.5.The severity of these events were not specified hence needs more analysis. Conclusion:With advanced anesthetic and surgical techniques, it is safe to undertake revascularization pre-transplant. Further research is required to formulate guidelines to categorize patients into medical and interventional groups.

Author(s): Rupinder kaur Kaiche, Rahul Kaiche, Nagesh Aghor

Abstract Full Text PDF

Get the App