| Home | E-Submission | Sitemap | Contact us |  
Korean J Crit Care Med > Volume 16(1); 2001 > Article
Korean Journal of Critical Care Medicine 2001;16(1): 11-16.
종설 : 신장이식의 수술 전후 관리
이종훈, 김명수, 전경옥, 김유선
연세대학교 의과대학 외과학교실 및 *원주의과대학 외과학교실
Perioperative Care for Kidney Transplantation
Jong Hoon Lee, Myoung Soo Kim, Kyung Ock Jeon, Yu Seun Kim
1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. yukim@yumc.yonsei.ac.kr
2Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
ABSTRACT
The evaluation of a patient referred for kidney transplantation is divided into 3 phases. First, a through evaluation is carried out, both to identify risk factors for undergoing transplantation. Second, a surgical evaluation is carried out to look for signs of vascular disease and urological abnormalities, and finally an immunologic evaluation is initiated to assess the patient's blood and HLA types. In patients with chest pain, chronic heart failure, or abnormal EEG, non-invasive cardiac test, when necessary followed by coronary angiography, is indicated. Patients with significant narrowing of the major coronary vessels should undergo percutaneous angioplasty or bypass grafting before transplantation. In diabetic patients over the age of 45, coronary artery disease is a common occurrence even in the absence of symptoms or clinical signs. Non-invasive cardiac evaluation during exercise should be performed routinely. The decision to perform a renal transplantation in a patient who has previously been treated for a malignancy is not an easy one. A waiting period of 2 years seems justified for most neoplasm. A waiting time of more than 2 years is required in malignant melanoma, breast carcinoma, or colorectal carcinomas. The advantages of immediate function after kidney transplantation include a higher long-term success rate, the ability to use potentially nephrotoxic immunosuppressive agents at an earlier time, shortened hospitalization and cost of the procedure as well as the avoidance of post-operative dialysis. Deliberate hydration of the patients during surgery is carried out in order to reduce the risk of acute tubular necrosis. This can be done with either crystalloid or colloid solution. The amount of intravenous solution depends on the patient's hydration status at the start of the procedure and CVP reading during the operation. Close monitoring of urine output is maintained in the early post-operative period. Intravenous hydration is maintained to keep up with the post-operative diuresis. Hypertension is very common in the post-operative period and must be controlled to reduce the risk of post-operative bleeding. If the patient is oliguric in the immediate post-operative period, an attempt at deliberate hydration is employed, however, if the oliguria persists, such hydration must be abandoned in order to avoid pulmonary edema. Dialysis will be required if the kidney does not function adequately. The price a transplant recipient pays for effective immunosuppression is an increased risk of developing infectious complications. Empirical administration of antibiotics, anti-viral agents, or anti-fungal agents in clinically declining patients is justified.
Key Words: Perioperative management; Kidney transplantation
TOOLS
PDF Links  PDF Links
Full text via DOI  Full text via DOI
Download Citation  Download Citation
CrossRef TDM  CrossRef TDM
  E-Mail
Share:      
METRICS
1,460
View
112
Download
Related articles
Critical Care after Lung Transplantation  2018 November;33(4)
Critical Care before Lung Transplantation  2018 November;33(4)
Hymodynamic Management for Cardiac Transplantation  1997 November;12(2)
Perioperative Thermal Pertubation  2000 June;15(1)
Perioperative Intensive Care for Liver Transplantation  2001 June;16(1)
Editorial Office
#805-806, Yongseong Biztel, 109 Hangang-daero, Yongsan-gu, Seoul 04376, Korea
TEL: +82-2-2077-1533   FAX: +82-2-2077-1535   E-mail: acc@accjournal.org
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Copyright © The Korean Society of Critical Care Medicine. All rights reserved.                 developed in m2community
Close layer
prev next