الفهرس 
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Abstract
Renal transplantation is now recognized as a treatment of choice for patients with chronic renal failure with end-stage renal disease. Renal transplantations are associated with better quality of life, better cost/benefit ratio, and possibly longer survival.
The grafted kidney’s outcome in the first few days is generally measured by urine output and serum creatinine values. Early graft malfunction has been associated with decreased graft survival and increased recipient complications. These factors initiated us to study the early graft function (urine output and biochemical parameters) in relation to the fluid dynamics during the surgery. The most important operative intra-operative measure, to improve immediate graft function, is to maintain an adequate intravascular volume and perfusion pressure.
Significant changes in blood pressure are common throughout the surgical procedure for kidney transplantation. The kidney transplantation procedure contains prolonged episodes of minimal stimulation. Maintenance of acceptable anesthetic depth to avoid awareness may reduce blood pressure and perfusion pressure to the newly reperfused kidney. In a large series of renal transplantations studied by Heino et al., (1986) hypotension (49.6%) was a more common finding than hypertension (26.8%) (6).
Hypotension is commonly encountered, especially after the fascia is dissected, and might be further exacerbated after reperfusion of the graft.
Allograft function, as determined by intraoperative urine production, is typically optimized by maintaining satisfactory intraoperative perfusion pressure. Preservation of adequate perfusion pressures to the graft is a main focus of intraoperative management during kidney transplantation. All efforts are made to maintain an appropriate level of blood pressure by using an adequate intravascular volume and vasopressor administration. Aggressive administration of fluid to optimize graft perfusion may be problematic in patients with a history of congestive heart failure and a low ejection fraction. Recipients undergoing kidney transplantation may suffer difficulty in maintaining adequate blood pressure without the use of inotropes. However, to our knowledge, there have been no previous studies assessing the requirements for vasoactive inotropes in patients undergoing kidney transplantation; neither have studies stating the superiority of one type of vasopressor over another.
Norepinephrine is an adrenergic agonist with a potent a-adrenergic receptor agonistic action; it is a relatively weak agonist at β-adrenergic receptors. Norepinephrine is an effective vasopressor for maintaining blood pressure with less tendency to decrease heart rate and cardiac output.
Dopamine is a commonly used vasoactive drug that acts in a stepwise manner on dopaminergic and adrenergic (a and β) receptors.
We undertook this study to investigate the effect of two types of vasopressors; norepinephrine versus dopamine, when used, for intraoperative and postoperative hemodynamic support in renal transplant recipients and their influence on the postoperative outcome regarding postoperative renal graft function.
This prospective, randomized clinical trial was carried out in Assiut University Hospital, Renal Transplantation Unit. After approval of the local ethics committee of Assiut University and obtaining written informed consent from all patients, 44 patients scheduled for living donor kidney transplantation were included. Patients were randomly allocated into two groups, group (N): the Norepinephrine infusion group (22 patients), and group (D): The dopamine infusion group (22 patients) to compare the two drugs as regards their efficacy in improving early graft function.
Results
Regarding age, gender, weight, height, BMI, duration of chronic RF, duration of dialysis was comparable between both groups. Also, anesthesia time, operation time, need blood transfusion, presence of complications and type of complications (dialysis, rejection, and hematoma) were insignificantly different between both groups.
Both groups showed MBP at baseline, 10min, 20min and 30min between both groups. Also, both had insignificant different HR at baseline, 10 min and 20 min. However, HR was significantly higher at 30 min in dopamine group than in nor epinephrine group (P value =0.031). Moreover, MBP and HR were significantly higher at 10 min, 20 min and 30 min compared to baseline in nor epinephrine group and dopamine group (P value <0.001).
Regarding CVP measurement was insignificantly different at baseline and 10 min between both groups and was significantly lower at 20 min and 30 min in dopamine group than in nor epinephrine group (P value =0.015 and 0.022 respectively). CVP was insignificantly different at 10 min, 20 min and 30 min compared to baseline in norepinephrine group while was significantly higher at 10min and lower at 20min and 30min compared to baseline in dopamine group (P value=0.031)
UOP was significantly higher at baseline and 20 min in dopamine group than in nor epinephrine group (P value=0.012 and 0.001 respectively) and was insignificantly different at 10 min and 30 min between both groups. UOP was significantly higher at 10 min, 20 min and 30 min compared to baseline in nor epinephrine group and dopamine group (P value <0.001).
Creatinine level was significantly higher at baseline in nor epinephrine group than in dopamine group (P value=0.009), and was insignificantly different at 4h, 12h and 24h between both groups. However, Urea and RRI were insignificantly different at baseline, 4h, 12h and 24h between both groups. In both groups, Creatinine and urea were significantly lower at 4h, 12h and 24 compared to baseline in nor epinephrine group and dopamine group (P value <0.05). Also, RRI was insignificantly different at 4h, 12h and 24 compared to baseline in nor epinephrine group and dopamine group.
HB 24 hrs, HCT 24 hrs, PLTs 24 hrs, WBCs 24 hrs and albumin 24 hrs were insignificantly different between both groups.