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Abstrak :
ABSTRAK
Latar Belakang Transplantasi ginjal telah menjadi pilihan utama terapi bagi pasien dengan penyakit ginjal tahap akhir, baik yang berasal dari donor hidup maupun donor jenazah. Transplantasi ginjal memiliki risiko yang lebih rendah baik untuk mortalitas maupun kejadian kardiovaskular, serta memiliki kualitas hidup yang lebih baik dibandingkan pasien yang menjalani dialisis kronis, baik hemodialisis maupun dialisis peritoneal. Penelitian ini bertujuan mengetahui faktor-faktor yang mempengaruhi kesintasan transplantasi ginjal di RSUPN Ciptomangunkusumo tahun 2010-2017.

Metode Penelitian Desain penelitian ini adalah kohort retrospekstif menggunakan data rekam medis pasien transplantasi ginjal. Sampel penelitian adalah resipien transplantasi ginjal ≥ 18 tahun di di RSUPN Ciptomangunkusumo tahun 2010-2017, yaitu sebanyak 548 pasien.

Hasil penelitian probabilitas kesintasan resipien transplantasi ginjal selama pengamatan 5 tahun adalah 84,1% Hasil analisis dengan regresi cox menunjukkan bahwa resipien dengan donor yang berusia ≥ 40 tahun lebih cepat 1,487 kali untuk meninggal dibandingkan resipien dengan donor yang berusia < 40 tahun, resipien yang berusia ≥ 45 tahun lebih cepat 2,356 kali untuk meninggal dibandingkan pasien yang berusia <45 tahun, lama hemodialisis ≥ 24 bulan lebih cepat 2,356 kali untuk meninggal dibandingkan pasien yang lama hemodialisisnya < 24 bulan, skor charlson > 1 lebih cepat 2,861 kali untuk meninggal dibandingkan pasien yang skor charlson ≤ 1, resipien yang memiliki DM lebih cepat 2,947 kali untuk meninggal dibandingkan dengan yang tidak DM.

Simpulan Kesintasan lima tahun di Indonesia cukup baik. Insiden kematian relatif tinggi, menyebabkan penurunan kelangsungan hidup pasien lima tahun. Namun, hasil keseluruhan masih sebanding dengan negara-negara berkembang lainnya

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ABSTRACT
Background Kidney transplantation has become the main choice of therapy for patients with end-stage kidney disease, both from living donors and donor bodies. Kidney transplantation has a lower risk for both mortality and cardiovascular events, and has a better quality of life than patients who undergo chronic dialysis, both hemodialysis and peritoneal dialysis. This study aims to determine the factors that influence the survival of kidney transplants in Ciptomangunkusumo Hospital in 2010-2017.

Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from March 2019 until May 2019. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or december 2018, whichever comes first. Five-year death and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study and analysis with Cox regression.

Result which was as many as 548 patients. The results of this study indicate the probability of survival of kidney transplant recommendations during the 5-year observation was 84.1%. The results of the analysis with Cox regression showed that donors aged ≥ 40 years were 1,487 faster to die than recipients with donor aged <40 years, prescriptions aged ≥ 40 years 2,356 times faster to die than patients aged <40 years, duration of hemodialysis ≥ 24 months faster 2,356 times to die compared to patients with long hemodialysis <24 months, Charles score> 1 faster 2,861 times to die than patients who score charlson ≤ 1, the recipients who have DM are 2.97 times faster to die compared to those without DM .

Conclusions The outcome of five-year death in Indonesia is very satisfactory. The incidence of death is relatively high, causing a decline in five-year patient survival. However, the overall results are still comparable to other developing countries.

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Though kidney transplantation is considered a routine procedure, there are still significant challenges in post-transplant management. Core Concepts in Renal Transplantation is a clinically focused authoritative guide to the management of kidney transplantation. This comprehensive, state-of-the-art reference summarizes the recent changes in the field of transplantation, offering the complete range of up-to-date information on all the various aspects of basic immunobiology and the medical care of the transplant recipient.

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Transplantasi ginjal TG merupakan salah satu terapi pilihan utama pada pasien Gagal Ginjal Terminal GGT . TG dapat meningkatkan kualitas hidup pasien GGT. Kualitas hidup dapat dipengaruhi oleh berbagai faktor, seperti faktor fisik, psikologis dan mental. Tujuan penelitian ini adalah untuk mengetahui faktor- faktor yang mempengaruhi kualitas hidup pasien TG. Desain Penelitian menggunakan Cross Sectional Study, Sampel dalam penelitian ini berjumlah 110 pasien TG dengan tehnik pengambilan sampel menggunakan metode purposive sampling. Instrumen penelitan menggunakan kuesioner kualitas hidup WHOQoL ndash; BREF, yaitu kuesioner yang telah banyak digunakan dalam mengukur kualitas hidup di dunia dan secara validitas dan reabilitas merupakan kuesioner yang valid dan reliabel. Analisi data menggunakan: proporsi, chi- square dan regresi logistik ganda. Hasil penelitian menunjukkan bahwa kualitas hidup pasien TG di RSUPN Dr. Cipto Mangunkusumo adalah baik 71, 8 . Faktor yang mempengaruhi kualitas hidup pasien adalah: usia p = 0,002 , pendidikan p = 0,001 pekerjaan p = 0,010 , dukungan keluarga p = 0,024 , dan kepatuhan pasien dalam mengkonsumsi obat immunosupressant p = 0,009 , faktor yang dominan mempengaruhi kualitas hidup adalah: pendidikan OR= 11, 490 dan kepatuhan dalam mengkonsumsi obat immunosuppressant OR= 10, 530. Kesimpulan: Kualitas hidup pasien TG dipengaruhi oleh, usia, pendidikan, pekerjaan, dukungan keluarga dan kepatuhan pasien dalam mengkonsumsi obat immunosupressant Rekomendasi: Penelitian lebih lanjut terkait dimensi kualitas hidup: dimensi fisik, psikologis, hubungan sosial dan lingkungan dan pemberian intervensi keperawatan berupa edukasi sebelum dan sesudah TG.

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Kidney transplantation KT is one of the major therapies in terminal renal failure. KT can increase Quality of Life QoL of the patients with terminal renal failure. QoL can be affected by several factors, such as physical, psychological and mental factors. The aim of this research is to identify the factors that affects QoL of KT patients. The research design used Cross Sectional Study, with purposive sampling. The samples of study is 110 KT patients. The research instrument uses WHOQoL ndash BREF, instrument WHOQoL ndash BREF has been widely used in measuring the QoL in the world and the validity and reliability is a valid and reliable questionnaire. Data analysis uses proportion, chi square and multiple logistic regression. The results of this research showed that the QoL of KT patients at General Hospital Cipto Mangunkusumo is good 71, 8 . The Factors influencing of the QoL of the patients were age, p 0,002, education p 0,001 occupation p 0,010 , family p 0,024 , and patient adherence to taking immunosuppressant drugs p 0,009. Conclusions The QoL of patients affected by age, education, occupation, family and patient adherence to taking immunosuppressant drugs. Recommendations Further research related to the dimensions of the Qol with are physical, psychological, social and environmental dimensions and Intervention of Nursing through prre and post opertif education of KT.

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Latar Belakang: Nyeri pascaoperasi pada laparotomi transplantasi ginjal dikategorikan pada nyeri sedang sampai berat. Tatalaksana nyeri yang efektif dapat membantu pemulihan yang lebih baik. Epidural kontinyu merupakan pilihan analgesia yang digunakan pada operasi laparotomi transplantasi ginjal di RSCM  namun ditemukan masih adanya pasien yang merasakan nyeri. Penelitian ini bertujuan untuk membandingkan efektivitas antara blok Quadratus Lumborum (QL) bilateral dengan blok epidural kontinyu terhadap derajat nyeri dan kebutuhan morfin pascaoperasi.

Metode: Penelitian ini merupakan uji kontrol acak pada 38 pasien yang menjalani operasi laparotomi resipien transplantasi ginjal di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Sesaat sebelum pasien diekstubasi, 20 subjek dalam kelompok blok QL bilateral mendapatkan ropivacaine 0,375% sebanyak 20 mL bilateral dan 18 subjek pada kelompok epidural kontinyu mendapatkan infus epidural ropivakain 0,2% 6 mL/jam. Hasil dari penelitian ini dianalisis dengan menggunakan uji statistik Mann Whitney. 

Hasil: Penelitian ini tidak menemukan perbedaan bermakna derajat nyeri VAS istirahat antara kelompok blok epidural dan kelompok blok QL pada saat di RR, jam ke-2, jam ke-6, jam ke-12, dan jam ke-24 (p = 0,228; 0,108; 0,224; 0,056 dan 0,179). Tidak terdapat perbedaan VAS bergerak antara kedua kelompok saat di RR, jam ke-2, jam ke-6, jam ke-12, dan jam ke-24 (p = 0,813; 0,865; 0,947; 0,063; dan 0,408). Kebutuhan morfin pada 24 jam pascaoperasi tidak menunjukkan perbedaan bermakna pada semua jam pengukuran (p = 0,380; 0,425; 0,664; 0,854). Waktu saat pertama kali menekan PCA morfin juga tidak bermakna dengan p 0,814. Ketinggian blok pada 1 jam pascaoperasi pada kedua kelompok sama, yaitu blokade 100% pada T10-L1. Tidak terdapat perbedaan dosis minimal dan maksimal dobutamin dan norepinefrin antara kelompok QL dan epidural kontinyu. Jumlah produksi urin 24 jam, skor Bromage, dan skor Ramsay tidak berbeda pada kedua kelompok.

Simpulan: Blok QL tidak memberikan efek analgesia yang lebih baik daripada blok epidural kontinyu.

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Background: Postoperative pain in laparatomy for kidney transplant is moderate to severe. Effective postoperative pain promotes better recovery. Continuous epidural is the current analgesia of choice in laparatomy for kidney transplant in Cipto Mangunkusumo Hospital; however, undermanaged pain was still reported. This study aims to compare the effectivity between bilateral Quadratus Lumborum block and continuous epidural in managing pain and reducing morphine requirement.

Methods: This is a randomized controlled study on 38 patients undergoing laparatomy for kidney transplant in Cipto Mangunkusumo Hospital. Before extubation, 20 subjects in QL group received 20 ml 0.375% ropivacaine while 18 subjects in continuous epidural group received epidural infusion of 0.2% ropivacaine at 6 ml/hour. The result was analysed using Mann Whitney test.

Results: This study found no difference between resting VAS score of QL and epidural group in recovery room, at 2^nd, 6^th, 12th, and 24^th hour (p = 0,228; 0,108; 0,224; 0,056 dan 0,179). There was no difference between moving VAS of both groups in recovery room, at 2^nd, 6^th, 12th, and 24^th hour (p = 0,813; 0,865; 0,947; 0,063; dan 0,408). Morphine requirement on 24^th hour post surgery showed no difference in all observed hours (p = 0,380; 0,425; 0,664; 0,854). Time to first PCA press was also insignificant (p 0,814). Block height at 1^st hour post surgery was the same in both groups, with 100% blockade at T10-L1. There were no difference at minimal and maximal dobutamine and norepinephrine dose in between the two groups. Total 24 hour urine production, Bromage score, and Ramsay score was not different in both groups.

 

Conclusion: QL block did not provide better analgesia compared to continuous epidural.

Abstrak :
Transplantasi ginjal dapat memperbaiki fungsi jantung Penelitianeksperimental pada binatang membuktikan bahwa peningkatan kadar hormoneritropoetin memperbaiki fungsi jantung namun secara klinis masih menjadi bahanperdebatan Tujuan: Untuk menilai hubungan peningkatan kadar eritropoetin dengan perbaikanfungsi jantung pada pasien gagal ginjal yang menjalani transplantasi Metoda: Penelitian Kohor prospektif pada pasien gagal ginjal yang menjalanitransplantasi di RSCM Jumlah subyek 21 orang yang dikumpulkan dalam kurunwaktu Maret September 2013 Pengambilan data ekokardiografi dan kadareritropoetin dilakukan sebelum dan 3 bulan sesudah transplantasi ginjal Analisisstatistik dengan uji korelasi Pearson atau Spearman Hasil: Penelitian ini menunjukkan peningkatan bermakna kadar eritropoetin 7 58 2 56 mlU ml menjadi 18 1 6 4 mlU ml Terdapat hubungan peningkatan kadareritropoetin dengan LVEDD r 0 56 p0 05 Kesimpulan: Terdapat hubungan peningkatan kadar eritropoetin dengan perbaikanLVH LVEDD pada pasien gagal ginjal yang menjalani transplantasi Tidak ada hubungan peningkatan kadar eritropoetin dengan perbaikan LVEF ......Kidney transplantation improved cardiac function Based on animaltrials elevated levels of erythropoietin hormone can improved cardiac function butin clinically still debate Aim: To determine association between elevated levels of erythropoietin andimprovement cardiac function on renal failure who underwent transplantation Methods: Prospective cohort study on renal failure who underwent kidneytransplantation at Cipto Mangunkusumo Hospital The study include 21 subjects whocollected it from Marct to September 2013 Data of echocardiography anderythropoietin level were collected at time prior to kidney transplantation and repeat 3months there after The association between elevated levels of erythropoietin andcardiac function was analyzed using Pearson correlation and Spearman test Results: The study showed a significantly elevated levels of erythropoietin from7 58 2 56 to 18 1 6 4 mlU ml There was statistically significant association between elevated levels of erythropoietin and LVEDD r 0 56 p Conclusions: There was association elevated levels of erythropoietin and improvement of LVH, LVEDD on renal failure who underwent transplantation, however, there was no association of elevated levels of erythropoietin level and improvement of LVEF.

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ABSTRAK
Penelitian ini dilakukan untuk menilai keamanan penggunaan klip polimer untuk kontrol vaskular pada nefrektomi donor hidup per laparoskopi. Kami mengumpulkan data secara retrospektif dari semua donor nefrektomi ginjal hidup per laparoskopi yang dilakukan di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia. Klip polimer digunakan untuk ligasi kedua arteri dan vena ginjal. Insidensi kegagalan klip polimer didokumentasikan untuk pendataan. Antara November 2011 dan Agustus 2015, kami mengevaluasi 260 pasien donor hidup dengan nefrektomi per laparoskopi. Ginjal kiri diambil dari 219 84,5 pasien. Arteri ginjal multipel ditemukan pada 25 9,6 pasien. Untuk semua kasus, kami menggunakan klip polimer untuk mengendalikan arteri ginjal XL dan L dan vena ginjal XL . Kami menempatkan 2 klip seproksimal mungkin ke aorta atau vena kava. Median estimasi perdarahan adalah 100 20 - 2000 ml. Perdarahan sebesar 2000 ml terjadi pada satu kasus, yaitu kasus klip terlepas. Rata-rata time to clip yaitu lamanya waktu dari sayatan pertama sampai ligasi arteri ginjal adalah 155 68 - 318 menit. Median warm ischemic time yaitu lamanya waktu dari ligasi arteri hingga cold ischemic time adalah 3,01 1,22 - 30,43 menit. Ada 10 kasus dengan warm ischemic time yang lebih dari 10 menit. Selain itu, terdapat 3 kasus 1,2 dengan kegagalan klip. Satu pasien membutuhkan konversi menjadi operasi terbuka untuk kontrol vaskular yang memadai. Dua pasien mengalami penguncian klip polimer yang tidak tepat, yang memerlukan pemasangan ulang klip. Penggunaan klip polimer untuk pengendalian vaskular pada nefrektomi donor hidup per laparoskopi relatif aman bila diterapkan dengan benar. Namun evaluasi tunggul vaskular ginjal setelah pengambilan ginjal donor merupakan langkah yang penting untuk memastikan penempatan dan keamanan klip polimer yang tepat.

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ABSTRACT
This study was conducted to assess the reliability and safety of polymer clips for vascular control in laparoscopic living donor nephrectomy. We collected data retrospectively from all laparoscopic living donor nephrectomy performed in Ciptomangunkusumo Hospital, Jakarta, Indonesia. Polymer clips was applied for both renal artery and renal vein ligation. The incidence of polymer clip failure was recorded accordingly. Between November 2011 and August 2015, we evaluated 260 patients of laparoscopic living donor nephrectomy. The left kidney was harvested from 219 84.5 patients. Multiple renal arteries was discovered in 25 9.6 patients. For all cases we used polymer clips to control the renal artery XL and L and renal vein XL . We placed 2 clips as proximal as possible to the aorta or caval vein. The median estimated blood loss was 100 20 ndash 2000 ml. A blood loss of 2000 ml occurred in one case of clip dislodgement. The median time to clip the length of time from first incision to renal artery clamping was 155 68 ndash 318 minutes. The median warm ischemic time the length of time from clamping to cold ischemic time was 3.01 1.22 ndash 30.43 minutes. There were 10 cases with warm ischemic time of more than 10 minutes. Three cases 1.2 of clip failures occurred. One patient needed conversion to open surgery to achieve adequate vascular control. Two patients experienced improper locking of the polymer clips, necessitating clips reapplication. The use of polymer clips for vascular control in laparoscopic living donor nephrectomy is reliable and safe when properly applied. However the evaluation of renal vascular stump after harvesting donor kidney is an important step to ensure the right placement and safety of polymer clips.

Abstrak :
Pendahuluan dan tujuan: Obstruksi ureter adalah salah satu komplikasi urologi yang paling sering dari transplantasi ginjal. Penelitian ini bertujuan untuk menganalisis faktor-faktor independen yang berkontribusi terhadap obstruksi ureter setelah transplantasi ginjal dan mengembangkan model prediksi dari faktor-faktor tersebut. Metode: Sebanyak 545 transplantasi ginjal dianalisis. Pasien menjalani transplantasi antara Januari 2014 dan Desember 2018. Analisis regresi logistik digunakan untuk mengembangkan model prediksi. Kedua karakteristik demografis donor dan resipien serta parameter operasi dianalisis dan disajikan. Hasil: Terdapat 37 (6,8%) subjek yang mengalami obstruksi ureter. Faktor risiko independen untuk obstruksi ureter adalah arteri ginjal allograft multipel, usia donor yang lebih tua (>38 tahun), dan usia resipien yang lebih tua (>60 tahun). Dari analisis kurva receiver operating characteristic (ROC), area di bawah kurva ROC model prediktif adalah 0,843 (P < 0,001). Subyek dengan >2 arteri ginjal allograft, usia resipien >60 tahun, dan usia donor >38 tahun memiliki kemungkinan 83,8% untuk mengalami stenosis ureter setelah transplantasi ginjal. Kesimpulan: Usia donor, usia resipien, dan arteri multipel merupakan faktor risiko independen dari obstruksi ureter graft. Probabilitas berkembangnya obstruksi ureter harus dipertimbangkan sebelum operasi pada populasi kami, menggunakan model prediksi yang diusulkan ......Introduction: Ureteral obstruction is one of the most frequent urologic complications of kidney transplantation. This study aimed to analyze independent factors that contribute to ureteral obstruction following kidney transplantation and develop predictive models form those factors. Methods: As many as 545 kidney transplantations were analyzed. Patients underwent transplantation between January 2014 and December 2018. Logistic regression analysis was used to develop the predictive model. Both donor and recipient demographic characteristics and operative parameters were analyzed and presented. Results: There were 37 (6.8%) subjects who developed ureteral obstruction. The independent risk factors for ureteral obstruction were multiple allograft renal arteries, older donor ages (>38 years), and older recipient age (>60 years). From the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve of the predictive model was 0.843 (P < .001). Subjects with >2 renal allograft arteries, recipient age >60 years, and donor age >38 years had 83.8% probability of developing ureteral stenosis after kidney transplantation. Conclusion: Donor age, recipient age, and multiple renal arteries were independent risk factors of graft ureteral obstruction. Probability of developing ureteral obstruction should be considered pre-operatively in our population, using the proposed predictive model.

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Background: living kidney donation is a safe medical procedure. Kidney function after donation is crucial for donors’ health and quality of life. Kidney hyperfiltration is a compensatory mechanism, which will preserve kidney function after unilateral nephrectomy. The number of studies regarding hyperfiltration in living kidney donors is limited. Our study aimed to explain kidney hyperfiltration mechanism and evaluate its effect on the kidney function within 30 days after surgery. Methods: our study was a prospective cohort study with 46 living-kidney donors participating in the study between April and December 2019. We evaluated main outcomes, the 30-day post-surgery kidney function, which was evaluated by calculating estimated glomerular filtration rate (eGFR) and Urinary Albumin to Creatinine Ratio (ACR). The subjects were categorized into two groups based on their 30-day outcomes, which were the adaptive (eGFR > 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) and maladaptive (eGFR < 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) groups. A series of evaluation including calculating the renal arterial resistive index (RI) and measuring urinary vascular endothelial growth factor (VEGF), neutrophil gelatinase-associated lipocalin (NGAL), and heparan sulfate (HS) levels were performed before surgery and serially until 30 days after surgery. Multivariate analysis with adjustments for confounding factors was done. Results: forty donors were included and mostly were female (67.5%). The average age and body mass index (BMI) were 45.85 (SD 9.74) years old and 24.36 (SD 3.73) kg/m2 , respectively. Nineteen donors (47.5%) had maladaptive hyperfiltration outcomes. The hyperfiltration process was demonstrated by significant changes in renal arterial RI, urinary VEGF, NGAL, and HS levels (p<0.005). There was no significant difference regarding RI, urinary VEGF, NGAL, and HS levels between both groups. Several confounding factors (BMI over 25 kg/m2 , familial relationship, age over 40 years old, and arterial stiffness) were significantly influenced by kidney hyperfiltration and outcomes (p<0.05). Conclusion: the hyperfiltration process does not affect the 30-day post-nephrectomy kidney function of the donors. Several other factors may influence the hyperfiltration process and kidney function. Further study is necessary to evaluate kidney function and its other related variables with a longer period of time study duration.