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| 1 | Hemodynamic management in brain dead donors显示文摘Donor management is the key in the complex donation process,since up to 20%of organs of brain death donors(DBD)are lost due to hemodynamic instability.This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities(marginal donors).In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management(focusing on vasoactive drugs)and monitoring(therapeutic goals).Evidence on management in elderly DBDs is also summarized.Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted.Careful monitoring of selected parameters(possibly including serial echocardiography)is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals.Despide worldwide differences,norepinephrine is the vasoactive of choice in most countries but,whenever higher doses(>0.2 mcg/kg/min)are needed,a second vasoactive drug(vasopressin)is advisable.Hormonal therapy(desmopressin,corticosteroid and thyroid hormone)are suggested in all DBDs independently of hemodynamic instability.In the single patient,therapeutic regimen(imprimis vasoactive drugs)should be chosen also according to the potential organs retrievable(i.e.heart vs liver and kidneys). | Chiara Lazzeri Manuela Bonizzoli Cristiana Guetti Giorgio Enzo Fulceri Adriano Peris | 2021 | World Journal of Transplantation2021，11，10： | 2 |
| 2 | Robot-assisted kidney transplantation:Is it getting ready for prime time?显示文摘Kidney transplantation(KT)is the treatment of choice for patients with end-stage renal disease,providing a better survival rate and quality of life compared to dialysis.Despite the progress in the medical management of KT patients,from a purely surgical standpoint,KT has resisted innovations during the last 50 years.Recently,robot-assisted KT(RAKT)has been proposed as an alternative approach to open surgery,especially due to its potential benefits for fragile and immunocompromised recipients.It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea,Development,Exploration,Assessment,Long-term follow-up recommendations for introducing surgical innovations into real-life practice.During the last years,mirroring the Vattikuti-Medanta technique,several centers developed RAKT program worldwide,providing strong evidence about the safety and the feasibility of this procedure.However,the majority of RAKT are still performed in the living donor setting,as an“eligible”procedure,while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation.In addition,despite the spread of minimally-invasive(predominantly robotic)surgery worldwide,many KTs are still performed in an open fashion.Regardless of the type of incision employed by surgeons,open KT may lead to nonnegligible risks of wound complications,especially among obese patients.Particularly,the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications.In this context,robotic surgery could offer several benefits,including providing a better exposure of the surgical field and better instrument maneuverability,as well as the possibility to integrate other technological nuances,such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis.Therefore,our review aims to report the more significant experiences regarding RAKT,focusing on the results and future perspectives. | Vincenzo Li Marzi Alessio Pecoraro Maria Lucia Gallo Leonardo Caroti Adriano Peris Graziano Vignolini Sergio Serni Riccardo Campi | 2022 | World Journal of Transplantation2022，12，7： | 0 |
| 3 | Haemodynamic management in brain death donors:Influence of aetiology of brain death显示文摘BACKGROUND In brain death donors(BDDs),donor management is the key in the complex donation process.Donor management goals,which are standards of care or clinical parameters,have been considered an acceptable barometer of successful donor management.AIM To test the hypothesis that aetiology of brain death could influence haemodynamic management in BDDs.METHODS Haemodynamic data(blood pressure,heart rate,central venous pressure,lactate,urine output,and vasoactive drugs)of BDDs were recorded on intensive care unit(ICU)admission and during the 6-h observation period(Time 1 at the beginning;Time 2 at the end).RESULTS The study population was divided into three groups according to the aetiology of brain death:Stroke(n=71),traumatic brain injury(n=48),and postanoxic encephalopathy(n=19).On ICU admission,BDDs with postanoxic encephalopathy showed the lowest values of systolic and diastolic blood pressure associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs.At the beginning of the 6-h period(Time 1),BDDs with postanoxic encephalopathy showed higher values of heart rate,lactate,and central venous pressure together with a higher need of other vasoactive drugs.CONCLUSION According to our data,haemodynamic management of BDDs is affected by the aetiology of brain death.BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs. | Chiara Lazzeri Manuela Bonizzoli Stefano Batacchi Cristiana Guetti Walter Vessella Alessandra Valletta Alessandra Ottaviano Adriano Peris | 2023 | World Journal of Transplantation2023，13，4： | 0 |
| 4 | Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support显示文摘BACKGROUND The prognostic role of right ventricle dilatation and dysfunction(RVDD)has not been elucidated in patients with coronavirus disease(COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation(ECMO)support.AIM To assess whether pre veno-venous(VV)ECMO RVDD were related to inintensive care unit(ICU)mortality.METHODS We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU(an ECMO referral center)from 31th March 2020 to 31th August 2021.An echocardiographic exam was performed immediately before VV ECMO implantation.RESULTS Males were prevalent(73.8%)and patients with a body mass index>30 kg/m^(2) were the majority(46/61,75%).The overall in-ICU mortality rate was 54.1%(33/61).RVDD was detectable in more than half of the population(34/61,55.7%)and associated with higher simplified organ functional assessment(SOFA)values(P=0.029)and a longer mechanical ventilation duration prior to ECMO support(P=0.046).Renal replacement therapy was more frequently needed in RVDD patients(P=0.002).A higher in-ICU mortality(P=0.024)was observed in RVDD patients.No echo variables were independent predictors of in-ICU death.CONCLUSION In patients with COVID-related respiratory failure on ECMO support,RVDD(dilatation and dysfunction)is a common finding and identifies a subset of patients characterized by a more severe disease(as indicated by higher SOFA values and need of renal replacement therapy)and by a higher in-ICU mortality.RVDD(also when considered separately)did not result independently associated with in-ICU mortality in these patients. | Chiara Lazzeri Manuela Bonizzoli Stefano Batacchi Giovanni Cianchi Andrea Franci Filippo Socci Marco Chiostri Adriano Peris | 2023 | World Journal of Cardiology2023，15，4： | 0 |
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