Systematic review of intra-operative duplex scanning during renal transplantation

Q3 Medicine
Linda Thebridge, Charles Fisher, Vikram Puttaswamy, Carol Pollock, Jillian Clarke
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引用次数: 3

Abstract

Introduction

A systematic review of the value of intra-operative duplex scanning during renal transplantation was undertaken.

Methods

Studies assessing intra-operative renal cortical flow in the arcuate vessels with outcomes of ultrasound directed interventions during the initial procedure, delayed graft function, post-operative resistive indices, graft losses and early returns to theatre for graft hypoperfusion were reviewed. PROSPERO registration: (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203873).

Results

Literature searching identified 2069 articles for screening, with 131 reviewed and 12 selected for analysis comprising 5 individual case reports, one case series of 11 patients and 6 non-randomised controlled trials. Studies with similar methodologies were pooled because of the low number of studies and outcomes. Outcomes of interest were not reported for all patients. Intra-operative interventions comprising graft repositioning in 18 (16%) and vascular revision in 2 (2%) were performed in 115 patients undergoing intra-operative scans. There were no graft losses or returns to theatre for graft hypoperfusion (0 of 108 cases) compared to 7 of 71 (10%) without intraoperative scanning (P = 0.003). Three of 8 (38%) patients with high intra-operative resistive indices (RIs) were returned to theatre for hypoperfusion compared to 1 of 110 (1%) patients with normal resistive indices (P = <0.001). Ten of 13 (77%) patients with high RIs had delayed graft function compared to 10 of 40 (25%) with normal RIs (P = 0.001).

Conclusion

Despite the absence of randomised controlled trials, and heterogeneous small studies, adverse outcomes were reduced with intra-operative scanning. High intraoperative RIs were predictive of both delayed graft function and return to theatre for hypoperfusion.

Abstract Image

肾移植术中双相扫描的系统回顾
本文对肾移植术中双相扫描的应用价值进行了系统回顾。方法回顾了术前超声引导干预、移植物延迟功能、术后阻力指数、移植物损失和早期因移植物灌注不足返回手术室的结果,评估术中肾弓状血管皮质血流的研究。普洛斯彼罗注册:(https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203873)。结果文献检索共筛选2069篇文章,其中131篇被审查,12篇被选择进行分析,包括5篇个案报告、1个病例系列(11例患者)和6项非随机对照试验。由于研究数量和结果较少,采用类似方法的研究被合并。没有报道所有患者的相关结果。术中干预包括移植物复位18例(16%)和血管修复2例(2%),对115例接受术中扫描的患者进行了手术。108例移植物灌注不足患者无移植物丢失或返院(0 / 108),而无需术中扫描的71例患者中有7例(10%)无移植物丢失或返院(P = 0.003)。8例术中阻力指数(RIs)高的患者中有3例(38%)因低灌注而返回手术室,而110例阻力指数正常的患者中有1例(1%)因低灌注而返回手术室(P = <0.001)。13例高RIs患者中有10例(77%)移植物功能延迟,而40例正常RIs患者中有10例(25%)移植物功能延迟(P = 0.001)。结论:尽管缺乏随机对照试验和异质小型研究,术中扫描减少了不良后果。术中高RIs可预测移植物功能延迟和因灌注不足而返回手术室。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Australasian Journal of Ultrasound in Medicine
Australasian Journal of Ultrasound in Medicine Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
1.90
自引率
0.00%
发文量
40
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