P007: DEVELOPMENT OF A CHECKLIST FRAMEWORK FOR KIDNEY TRANSPLANTATION.
Ahmed Zaghw, MD; Masoud Turbay; Raveh Yehuda; Joshua Livingstone; Shatz Vadim; Fouad Souki; Ramona Nicolau-Raducu; Jackson Memorial Hospital
Background: Kidney transplantation is the therapy of choice for patients with end-stage kidney disease, and one of the fastest growing transplant surgeries worldwide. Rates of early and late transplant failure remain unacceptably high despite modifiable factors. While checklists have been implemented in several surgical fields to increase patient safety and improve outcomes, they are unavailable in the transplant arena, largely due to the immense variability in clinical practices between transplant centers. We, therefore, propose a combined anesthetic-surgical perioperative checklist framework aiming at reducing adverse events, and improving the perioperative care of patients undergoing kidney transplant.
Methods: The anesthesia-surgical checklist was based on the English-language PubMed review of literature regarding patient safety, as well as existing practices in the field of kidney transplantation. The most relevant articles were combined with our own center’s experience and incorporated into the checklist.
Results: The two main areas of the checklist are recipient and donor variables. Reducing the risk of complications and adverse outcomes requires: (1) A Detailed pretransplant assessment of the candidate should include history, a thorough physical examination, dialysis details, a review of radiological, cardiac workup, medication and laboratory studies, serology, and final cross-match results. The preoperative assessment of donor/graft should include donor comorbidities and biopsy results. (2). Variables of the hypothermic machine perfusion of the kidney, e.g duration and resistance, are among clinical factors that have been showed to impact graft function and survival. (3). A standard pre-induction verification process should be conducted to confirm patient identity, procedure, site marking, and ABO compatibility. (4). The intraoperative choices of intravenous fluid, hemodynamic monitoring, and predetermined hemodynamics goals, as well as the timely administration of antibiotics and anti-rejection induction medications appear to improve short term outcome. (5). Precise and clear perioperative communication between members of the multidisciplinary-care team is essential.
Conclusion: We present a novel standardized combined anesthesia-surgical checklist framework for kidney transplant aimed at increase perioperative safety, enhance transplant outcomes, and streamline the perioperative care for kidney transplant patients. Future validation studies will determine its clinical feasibility and post-implementation efficacy.
1. Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation: A retrospective, single center study Mendez NV et al; World J Transplant 2021
2. Kidney Donor Profile Index (KDPI) and donor selection; Gupta A, et al; American Journal of Transplantation, Editorial, 2014
3. Hypothermic machine perfusion in kidney transplantation De Deken J et al; Current Opinion in Organ Transplantation 2016
4. Verifying patient identity and site of surgery: improving compliance with protocol by audit and feedback; P Garnerin et al; BMJ Quality Safety 2008
5. Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists Wagener G et al; Transplantation 2021