Operative Versus Nonoperative Management of Hemorrhage in the Postoperative Kidney Transplant Patient

The American Surgeon
Jacentha BuggsVictor Bowers

Abstract

Postoperative hemorrhage has been described at rates of 14% in kidney transplant (KT) literature. The preferred management of postoperative hemorrhage in this population is not well described. We hypothesized a difference in outcomes with operative versus nonoperative management of hemorrhage after kidney transplantation. We conducted a retrospective cohort study of consecutive KTs from 2012 to 2019 (living and deceased donors). We defined hemorrhage based on the objective finding of hematoma on either ultrasound or CT scan. Management was defined as operative (surgical intervention with or without transfusion) or nonoperative (with or without transfusion). We performed 1758 KTs of which 135 (8%) demonstrated hematoma on ultrasound or CT scan (66 operative vs 69 nonoperative management). The clinical signs and symptoms of low urine output (P = .044), drop in hemoglobin (P < .001), abdominal pain (P = .005), and MAP < 70 mm Hg (P = .034) were 92.5% predictive of postoperative hemorrhage in our KT patients. There were no differences between groups based on medical history, preop anticoagulation, anastomosis type, cold ischemic time, lowest hemoglobin, delayed graft function, or complications. Patients with nonoperative treatment ...Continue Reading

References

Jul 1, 1989·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·S HuraibP R Uldall
Jul 6, 2006·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Domingo HernándezArmando Torres
May 7, 2008·International Urology and Nephrology·Guido FechnerStefan C Müller
May 9, 2009·Transplantation·Juan C ScornikHerwig-Ulf Meier-Kriesche
Nov 1, 2006·Clinics in Colon and Rectal Surgery·Kerry L Hammond, David A Margolin
Oct 9, 2013·Current Opinion in Nephrology and Hypertension·John P HarmonDeborah L Zimmerman
Sep 21, 2016·Polski przeglad chirurgiczny·Wojciech FigielMarek Krawczyk
Jan 26, 2017·Transplant International : Official Journal of the European Society for Organ Transplantation·Laureen D HachemSang Joseph Kim
Nov 14, 2017·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Zhobin MoghadamyeghanehRodrigo Vianna

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