老年肾脏和肝脏移植受者的围手术期注意事项:综述。

IF 5.3 2区 医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2024-11-01 Epub Date: 2024-04-01 DOI:10.1097/TP.0000000000005000
Emily L Chanan, Gebhard Wagener, Elizabeth L Whitlock, Jonathan C Berger, Mara A McAdams-DeMarco, Joseph S Yeh, Mark E Nunnally
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引用次数: 0

摘要

随着老年人口的增长,等待和接受肾脏和肝脏移植手术的老年人数量也在增加。移植是针对这一人群的一种重要而明确的治疗方法。我们对 65 岁以上患者在接受肾脏或肝脏移植时所面临的术前、术中和术后独特问题进行了当代回顾。我们将重点放在老年综合症上,这些综合症在列入肾脏或肝脏移植名单的老年患者中很常见,包括虚弱、肌肉疏松症和认知功能障碍;讨论老年移植受者的重要注意事项,这可能会影响术前风险分层;并描述老年患者在术中和术后管理中面临的独特挑战。老年人术中面临的挑战包括使用循证最佳麻醉方法、保持足够的灌注压力以及使用微创手术技术。术后关注的问题包括控制术后急性疼痛;预防心血管并发症和谵妄;优化免疫抑制;预防围手术期肾脏损伤;以及避免肾毒性和康复。未来需要对整个围手术期进行研究,以确定能改善患者术前生理状态、预防术后医疗并发症以及改善这一脆弱患者群体的医疗和以患者为中心的治疗效果的干预措施。
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Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review.

With the growth of the older adult population, the number of older adults waitlisted for and undergoing kidney and liver transplantation has increased. Transplantation is an important and definitive treatment for this population. We present a contemporary review of the unique preoperative, intraoperative, and postoperative issues that patients older than 65 y face when they undergo kidney or liver transplantation. We focus on geriatric syndromes that are common in older patients listed for kidney or liver transplantation including frailty, sarcopenia, and cognitive dysfunction; discuss important considerations for older transplant recipients, which may impact preoperative risk stratification; and describe unique challenges in intraoperative and postoperative management for older patients. Intraoperative challenges in the older adult include using evidence-based best anesthetic practices, maintaining adequate perfusion pressure, and using minimally invasive surgical techniques. Postoperative concerns include controlling acute postoperative pain; preventing cardiovascular complications and delirium; optimizing immunosuppression; preventing perioperative kidney injury; and avoiding nephrotoxicity and rehabilitation. Future studies are needed throughout the perioperative period to identify interventions that will improve patients' preoperative physiologic status, prevent postoperative medical complications, and improve medical and patient-centered outcomes in this vulnerable patient population.

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来源期刊
Transplantation
Transplantation 医学-免疫学
CiteScore
8.50
自引率
11.30%
发文量
1906
审稿时长
1 months
期刊介绍: The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation. ​
期刊最新文献
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