[Efficacy of remifentanil in anesthetic management for living-donor renal transplantation].

BACKGROUND: We used fentanyl and remifentanil in living-donor renal transplantation patients. So, we have compared both drugs in renal function. METHODS: We used the volatile anesthetic sevoflurane as the base in 30 living-donor renal transplantation patients, dividing them into a remifentanil anesthesia group of 15 patients and a fentanyl anesthesia group of 15 patients, and compared their creatinine, BUN, and serum K values before surgery, and 1 day as well as 3 days after surgery. RESULTS: The results showed improvement in their values, and there were no significant differences between the two groups. CONCLUSIONS: Since more patients in the remifentanil group had adequate diuresis beginning immediately postoperatively without taking a diuretic, remifentanil appears to be a more suitable drug to use for anesthesia for living-donor renal transplantation.

[Drug eruption during living-donor renal transplantation in which it was difficult to identify the causative drug: a case report].

A 59-year-old man with renal failure given oral medication for the symptoms associated with it had no drug allergies before surgery. The patient received 8 units of FFP for a surgery of gastric tumor. The stomach tumor was benign, and living-donor renal transplantation was performed. After the living-donor transplantation, extensive reddening and swelling were observed over the patient's entire body. Anaphylaxis due to drug allergy was considered, and the patient's course was monitored. The flare and swelling tended to regress, and after about 3 hours they were resolved. The following day the drugs used intraoperatively were tested, but it was difficult to identify any allergy-inducing drugs. Ultimately, the FFP was suspected as the cause, and the patient appeared to have been saved by the methylprednisolone used as an immunosuppressive agent.

[Anesthetic management of a patient with mitochondrial encephalomyopathy for renal transplantation].

A 52-year-old man with mitochondorial encephalomyopathy was scheduled for renal transplantation from a living donor. He had some characteristic features including muscle weakness, deafness, cerebellar ataxia, diabetes meritus and renal failure. Anesthesia was induced with bolus infusion of propofol 1 mg x kg(-1) and continuous infusion of remifentanil at 0.15 microg x kg(-1) x min(-1) was started. After supporting ventilation for three minutes, the trachea was intubated without any muscle relaxant. Anesthesia was maintained with sevoflurane (0.4-1.0%), air and oxygen (33-50%) and with continuous infusion of 0.1-0.15 microg x kg(-1) x min(-1) of remifentanil without any muscle relaxant. The circulatory status was maintained with 1-5 microg x kg(-1) x min(-1) of dopamine depending on changes of CVP and BP. At the conclusion of the operation, respiratory depression lasted for about 25 minutes. After administration of naloxone 40 microg to antagonize the action of remifentanil, the patient recovered fully from the respiratory depression. The urine output was depressed initially after implantation of donor's kidney, but gradually increased to a usual recovery pattern. This case suggests that careful administration of remifentanil is mandatory in a patient with mitochondorial encephalomyopathy which enhances respiratory depression from opioids.

Improved outcomes after ABO-incompatible living-donor kidney transplantation after 4 weeks of treatment with mycophenolate mofetil.

Hyperacute humoral rejection of ABO-incompatible kidney transplants limits the application of this procedure. We evaluated the effect of 4-week treatment with mycophenolate mofetil (MMF), a compound that inhibits antibody production by B cells, before ABO-incompatible living-donor kidney transplantation with tacrolimus as the primary immunosuppressant. In contrast with cases without MMF pretreatment, we did not observe any graft loss caused by hyperacute humoral rejection in the 18 patients who received MMF. Overall, the incidence of adverse events was comparable in the MMF-treated and -untreated groups. The administration of MMF 4 weeks before kidney transplant effectively inhibits B-cell function, suggesting a potential role for MMF in the prevention of humoral rejection.