Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
[Latar Belakang Transplantasi ginjal adalah modalitas terapi pengganti ginjal yang paling baik bagi pasien dengan Penyakit Ginjal Tahap Akhir (PGTA). Saat ini di Indonesia transplantasi ginjal dengan donor hidup mulai semakin sering dilakukan, terutama di RSUPN Cipto Mangunkusumo, di mana dalam beberapa tahun terakhir lebih dari 50% kasus transplantasi ginjal di Indonesia dilakukan di rumah sakit ini. Walaupun demikian, data mengenai hasil transplantasi di Indonesia, baik kesintasan 1 tahun graft maupun pasien, serta faktor yang diduga mempengaruhinya masih belum ada. Diharapkan hasil transplantasi di rumah sakit ini dapat menggambarkan hasil secara keseluruhan di Indonesia. Metode Studi kohort retrospektif pada resipien transplantasi ginjal di RSUPN-CM dari Januari 2010 hingga Mei 2014. Data didapatkan dari penelusuran rekam medis serta menghubungi pasien secara langsung. Masing-masing resipien diikuti sejak tanggal transplantasi hingga kematian atau Mei 2015. Proporsi kesintasan graft dan pasien pada 1 tahun post transplantasi dan pada akhir studi didokumentasikan. Kurva Kaplan-Meier digunakan untuk menggambarkan kesintasan pasien secara keseluruhan. Studi deskriptif dilakukan dengan melihat perbedaan proporsi variabel serta perbedaan rerata atau median pada pasien yang mengalami kegagalan graft 1 tahun serta tidak, serta pasien yang bertahan hidup atau meninggal. Hasil Berdasarkan hasil consecutive total sampling didapatkan 157 resipien yang menjalani transplantasi ginjal di RSUPN-CM, 137 resipien di antaranya memenuhi kriteria penelitian, seluruhnya mendapatkan ginjal dari donor hidup. Usia resipien rata-rata adalah 47,9 ± 13,9 tahun, rerata IMT 22,8 ± 3,7 kg/m2, dan proporsi resipien dengan diabetes 35,8%. Didapatkan 7 pasien mengalami disfungsi graft primer (kegagalan transplantasi), sehingga 130 pasien diikuti untuk melihat kesintasan jangka panjang. Pada akhir tahun pertama, didapatkan angka death-censored graft survival adalah 95,4%, all-cause graft survival 85,4%, kesintasan pasien 88,5%, dan death with a functioning graft sebesar 10%. Pada akhir studi, didapatkan angka kesintasan tersebut berturut-turut adalah 94,6%, 80%, 82,3%, dan 14,6%, dengan median waktu pengamatan 24 bulan (1 ? 64 bulan). Kurva Kaplan Meier menunjukkan angka mortalitas tertinggi didapatkan pada bulan-bulan awal post transplantasi. Kegagalan graft dan kematian didapatkan lebih banyak pada resipien yang berusia lebih tua, mengidap diabetes melitus, serta memiliki indeks komorbiditas yang tinggi. Penyebab kematian utama adalah infeksi (11,5%) diikuti dengan kejadian kardiovaskular (3,8%). Simpulan Death-censored graft survival 1 tahun resipien transplantasi ginjal di Indonesia sudah sangat memuaskan. Angka death with functioning graft masih cukup tinggi, sehingga menurunkan all-cause graft survival dan kesintasan pasien 1 tahun. Walaupun demikian, secara keseluruhan hasil ini masih sebanding dengan negara-negara berkembang lainnya.;Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries;Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries;Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries, Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 – 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries]

Abstrak :

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.

---

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 :
Latar Belakang: Transplantasi ginjal merupakan tata laksana utama pada pasien dengan end-stage renal disease. Salah satu perubahan pascatransplantasi ginjal adalah adaptasi fungsi penyimpanan (storage) dan pengosongan (voiding) dari traktus urinarius bagian bawah dalam enam bulan pertama pascatransplantasi ginjal dimana retensi urine dapat terjadi. Tujuan: Penelitian ini bertujukan mengetahui prevalensi retensi urine pascatransplantasi ginjal dan untuk mendeskripsikan karakteristik urodinamik pasien pascatransplantasi ginjal dengan retensi urine. Metode: Penelitian ini merupakan penelitian studi potong lintang yang dilaksanakan di RSUPN Dr. Cipto Mangunkusumo pada tahun 2011-2017. Data diambil dari pasien pascatransplantasi ginjal yang dilakukan pemeriksaan urodinamik Data diambil dari rekam medis pasien. Hasil: Sebanyak 536 pasien menjalani transplantasi ginjal di RSCM, di antaranya terdapat 11 pasien (2%) disfungsi berkemih yang menjalani pemeriksaan urodinamik dengan rerata usia 41,4 (30,1±52,6) tahun, dimana dua orang diantaranya adalah perempuan. Enam pasien (55%) memiliki diabetes melitus (DM) tipe 2 dan 5 pasien (45%) memiliki hipertensi (HT). Sebanyak 6 dari 11 pasien (54%) mengalami retensi urine, empat pasien (36%) mengeluhkan keluhan frekuensi, dan satu pasien (10%) mengeluh adanya hesitancy dan perasaan tidak lampias setelah miksi. Sebanyak 50% pasien mengalami penurunan bladder compliance, dimana dua pasien (33%) di antaranya mengalami retnesi urine dengan normal bladder compliance. Overaktivitas detrusor ditemukan pada total empat pasien (36%) dan tiga pasien (50%) pada pasien dengan retensi urine. Sebanyak 4 pasien (36%) mengalami bladder outlet obstruction (BOO) dan 50% pasien dengan retensi urine mengalami BOO. Dua pasien juga didiagnosis mengalami instabilitas detrusor yang mana tidak disertai inkontinensia. Dua pasien (44%) memiliki kontraksi kandung kemih normal. Kesimpulan: Disfungsi berkemih dan retensi urine ditemukan sebanyak 2% dan 1,1% dari 536 pasien pascatransplantasi ginjal. Sebagian besar pasien dengan retensi urine memiliki DM tipe 2. BOO dan overaktivitas detrusor ditemukan pada pasien dengan disfungsi berkemih dan retensi urine. Pemeriksaan rutin urodinamik pada pasien sebelum transplantasi ginjal juga disarankan. ......Background: Kidney transplantation is the main treatment for patients with end-stage renal disease. After undergone kidney transplantation, changes in storage and voiding functions of the lower urinary tract in the first six months post-transplantation of the kidney is still occurring. During this period urinary retention can occur. Objective: This study aimed to determine the prevalence of urinary retention after kidney transplantation and to describe the urodynamic characteristics of post-transplant kidney patients with urinary retention. Method: This research is a cross-sectional study conducted at Cipto Mangunkusumo National General Hospital in 2011-2017. Data are collected from patients undergone urodynamic examination after kidney transplantation. Data are collected from the patient's medical record. Results: A total of 536 patients underwent kidney transplants in RSCM, including 11 patients (2%) urinary dysfunction who underwent urodynamic examination with an average age of 41.4 (30.1 ± 52.6) years including 2 women. Six patients (55%) had type 2 diabetes mellitus (DM) and 5 patients (45%) had hypertension (HT). A total of 6 out of 11 patients (54%) experienced urinary retention, four patients (36%) complained of frequency complaints, and one patient (10%) complained of hesitancy and feeling of incomplete emptying. As many as 50% of patients experienced a decrease in bladder compliance, of which two patients (33%) experienced urine retention with normal bladder compliance. Detrusor overactivity was found in four patients (36%) from total sample and three subjects (50%) among patient with urinary retention. Four patients (36%) experienced bladder outlet obstruction (BOO) and 50% of patients with urine retention experienced BOO. Two patients were diagnosed with detrusor instability which was not accompanied by incontinence. Two patients (44%) had normal bladder contractions. Conclusion: Urinary dysfunction and urinary retention were found in 2% and 1.1% of 536 patients after renal transplantation respectively. Most patients with urinary retention have DM type 2. BOO and detrusor overactivity are found in patients with urinary dysfunction and urinary retention. Routine urodynamic examinations in patients before a kidney transplant are also recommended.

Abstrak :
Latar Belakang: Proses hiperfiltrasi yang ditandai sebagai perubahan dinamik Renal Resistive Index (RRI) merupakan mekanisme adaptasi ginjal pasca berkurangnya massa nefron sudah banyak dielaborasi pada ginjal sisa donor transplan pasca nefrektomi. Belum diketahui bagaimana proses hiperfiltrasi dan rentang nilai RRI normal pada ginjal allograft. Tujuan: Membandingkan proses hiperfiltrasi berdasarkan perubahan dinamis nilai RRI, Peak systolic velocity (PSV), and End Diastolic Velocity (EDV) pada pemeriksaan ultrasonografi pasca operasi hingga satu bulan pasca transplantasi pada kelompok ginjal allograft dan ginjal sisa donor pasangan resipien-donor transplantasi ginjal. Metode: Studi prospektif pada 62 subyek yang merupakan 31 pasangan donor dan resipien transplantasi ginjal yang menjalani operasi transplantasi ginjal di RS dr. Ciptomangunkusumo dari Juli 2023 hingga Februari 2024. Pemeriksaan ultrasonografi dilakukan sebelum operasi, hari ke-7 setelah operasi, dan hari ke-30 setelah operasi. Nilai RRI, PSV, dan EDV dinyatakan dalam nilai rerata dan simpangan baku, dengan perbedaan kedua kelompok nilai menggunakan uji t berpasangan. Hasil: Nilai RRI a. segmental ginjal allograft dan ginjal sisa donor secara berturut-turut saat sebelum operasi, tujuh hari pasca operasi, dan tiga puluh hari pasca operasi adalah 0,61 ± 0,06 vs 0,61 ± 0,06 (p < 0,52), 0,62 ± 0,06 vs 0,68 ± 0,06 (p < 0,001), 0,61 ± 0,06 vs 0,67 ± 0,06 (p < 0,001). Nilai RRI a. arcuata ginjal allograft dan ginjal sisa donor secara berturut-turut saat sebelum operasi, tujuh hari pasca operasi, dan tiga puluh hari pasca operasi adalah 0,56 ± 0,05 vs 0,56 ± 0,05 (p < 0,83), 0,58 ± 0,06 vs 0,62 ± 0,07 (p < 0,05), 0,57 ± 0,06 vs 0,62 ± 0,06 (p < 0,001). Tidak terdapat perbedaan signifikan nilai PSV dan EDV kedua grup. Kesimpulan: Hiperfiltrasi pada ginjal allograft terjadi dengan pola serupa dengan ginjal residu donor transplantasi, dengan perbedaan nilai rerata RRI pada kedua kelompok. ......Background: Hyperfiltration, characterized as a dynamic change in the Renal Resistive Index (RRI), is an adaptation mechanism following reduction in nephron mass, has been elaborated on residual kidneys of transplant donors. It is not yet known how the hyperfiltration process is and the range of normal RRI values in allograft kidneys. Objective: To study the difference of RRI, Peak Systolic Velocity (PSV), and End Diastolic Velocity (EDV) dynamic changes of the allograft kidney and the remaining kidney of the donor, pairs of recipient-donor before transplantation until up to one month after transplantation Method: Prospective study of 62 subjects who were 31 pairs of donor and kidney transplant recipients who underwent kidney transplantation at dr. Ciptomangunkusumo- Hospital from July 2023 - February 2024. Ultrasonography is carried out before surgery, seventh day after surgery, and thirtieth days after surgery. RRI, PSV, and EDV is expressed in mean and standard deviation, with differences between two groups are compared using t-paired test. Results: Comparison of RRI value of segmental artery of allograft kidney and donor residual kidney, before surgery, seventh day, and thirtieth day post nephrectomy/transplantation consecutively are 0,61 ± 0,06 vs 0,61 ± 0,06 (p < 0,52), 0,62 ± 0,06 vs 0,68 ± 0,06 (p < 0,001), 0,61 ± 0,06 vs 0,67 ± 0,06 (p < 0,001). Comparison of RRI value of arcuate artery of allograft kidney and donor residual kidney, before surgery, seventh day, and thirtieth day post nephrectomy/transplantation consecutively are 0,56 ± 0,05 vs 0,56 ± 0,05 (p < 0,83), 0,58 ± 0,06 vs 0,62 ± 0,07 (p < 0,05), 0,57 ± 0,06 vs 0,62 ± 0,06 (p < 0,001). No differences of PSV and EDV values between two groups. Conclusion: Hyperfiltration in allograft kidneys occurs in a similar pattern to transplant donor residual kidneys, with significant differences in mean RRI values between two groups.

Abstrak :
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.

---

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 :
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.

---

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.

Abstrak :
ABSTRAK Penilaian preoperatif dan perioperatif dibutuhkan untuk memprediksi morbiditas dan mortalitas pasien pasca transplantasi ginjal. Oleh karena itu,modalitas yang digunakan dalam menilai risiko pembedahan harus memiliki akurasi dan objektivitas yang baik. Salah satu modalitas yang banyak digunakan di RSCM adalah skor ASA-PS. Namun skor ini sudah banyak ditinggalkan oleh negara maju dan beralih pada skor P-POSSUM yang dinilai lebih superior,objektif dan akurat. Pada penelitian ini, skor P-POSSUM diuji dalam memprediksi lama rawat inap pasien yang merupakan marker morbiditas pascabedan. Penelitian ini menguji kemampuan korelasi dan diskriminasi skor P-POSSUM dalam memprediksi lama rawat inap sekaligus menganalisis hubungan antar variabel skor P-POSSUM dengan lama rawat inap resipien transplantasi ginjal. Penelitian ini menggunakan studi kohort retrospektif yang dilakukan pada 225 resipien transplantasi ginjal dari di RSCM Pusat dan Kencana dan memenuhi kriteria inklusi dan eksklusi. Data rekam medis pasien digunakan untuk menelusuri variabel fisiologis dan pembedahan yang tercantum dalam skor P-POSSUM serta lama rawat inap pasien pasca transplantasi ginjal. Selanjutnya data dianalisis menggunakan bivariat dan regresi logistik untuk mendapatkan hubungan antar variabel P-POSSUM dengan lama rawat pasien. Kemampuan korelasi dan diskriminasi skor P-POSSUM dicari menggunakan Hamer-Lameshow dan AUC pada kurva ROC. Hasil analisis bivariat menunjukan terdapat lima variabel yang memiliki hubungan signifikan dengan lama rawat inap yaitu laju nadi, kadar hemoglobin,kadar leukosit,kadar kalium,total perdarahan intraperioperatif dan kontaminasi intraperitoneal. Namun hanya terdapat dua variabel yang signifikan dalam analisis multivariat yaitu kadar hemoglobin dan perdarahan intraoperatif. Kemampuan kalibrasi menggunakan Hosmer-Lameshow dinilai baik (Nilai p= 0.889). Namun kemampuan diskriminasi dinilai lemah karena AUC yang didapat 65.7%. Kesimpulannya, sistem skor P-POSSUM tidak dapat menentukan lama rawat pasien resipien transplantasi ginjal. Namun terdapat dua variabel P-POSSUM yang merupakan faktor prediktif lama rawat inap yaitu kadar hemoglobin dan perdarahan intraoperatif.

---

ABSTRACT
Preoperative and perioperative assessments are important to predict morbidity and mortality in post kidney transplant patient. Therefore, clinicians should assess operative risks by using accurate and objective modality.The most widely used modality in RSCM is ASA-PS score. Meanwhile, this score is no longer used in developed country and replaced by P-POSSUM score, which is more superior,objective, and accurate. In this study, P-POSSUM Score is assessed in predicting length of hospital stay as a marker of post-operative morbidity. This study examines the correlation and discrimination ability of P-POSSUM score in predicting length of hospital stay as well as analyzing relationship between P-POSSUM score variables and the length of hospita stay of kidney transplant recipients. This retrospective cohort study was conducted on 225 kidney transplant recipients from RSCM and RSCM Kencana who met the inclusion and exclusion criteria. Medical record of patient is used to identify the physiological and surgical variables in P-POSSUM Score and length of hospital stay of patients after kidney transplant. Furthermore, the data were analyzed using bivariate ad logistic regression to identify the relationship between P-POSSUM variables and the length of hospital stay. The correlation and discrimination ability of P-POSSUM score are examined by using Hamer-Lameshow and AUC on the ROC curve. The result of bivariate analysis showed that there are five variables that had a significant relationship with length of stay, namely pulse rate, hemoglobin level,leukocyte level,potassium level, total intraoperative bleedig and intraoperitoneal contamination. However, only two remains significant in the multivariate analysis namely hemoglobin level and intraoperative bleeding. Calibration ability is good based on Hamer-Lameshow analysis (p=0.889). But the ability to discriminate is considered weak because the AUC area only 65.7%. P-POSSUM can not be used to predict the length of hospital stay in kidney transplant recipients . Hemoglobin level and intraoperative bleeding are predictive factors in P-POSSUM for length of hospital stay od kidney transplant recipients.

Abstrak :
ABSTRAK
Latar Belakang: Laparoskopi merupakan prosedur yang menguntungkan pada operasi transplantasi ginjal . Namun teknik ini dapat menyebabkan perubahan pada sistem pernafasan. Pengaturan volume tidal merupakan salah satu strategi proteksi untuk mencegah komplikasi paru pascaoperatif. Penelitian ini berusaha membandingkan efek volume tidal 6 mL/kgbb dan 10 mL/kgbb terhadap distribusi ventilasi pada pasien donor transplantasi ginjal yang menjalani nefrektomi per laparoskopi menggunakan EIT. Metoda: Uji klinis ini dilakukan di Instalasi Bedah Pusat RSUPN Cipto Mangunkusumo dan ruang operasi RSCM Kencana Jakarta terhadap 30 pasien donor transplantasi ginjal yang menjalani laparoskopi nefrektomi. Subjek dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik intraoperatif dengan volume tidal 6 mL/kgbb dan 10 mL/kgbb. Hipotesis penelitian adalah distribusi ventilasi volume tidal 6 mL/kg lebih baik dibandingkan 10 mL/kg. Parameter yang dinilai adalah ?TIV, ?EELI global dan regional dan ?CR diambil dari monitor EIT PulmoVista 500 .Hasil: Nilai ?TIV paru dependen dan nondependen antara kedua kelompok berbeda bermakna secara statistik pada posisi supine pascadesuflasi p =0,008 , dimana volume tidal 6 mL/kgbb menunjukkan distribusi ventilasi tidak homogen. Nilai ?EELI global dan regional volume tidal 10 mL/kg lebih tinggi dan bermakna secara statistik pada posisi lateral dekubitus sebelum insuflasi p

---

ABSTRACT
Background Laparoscopy is a procedure that is profitable on a kidney transplant operation. However, this technique may cause changes in the respiratory system. Tidal volume setting is one of protection strategies for preventing pulmonary complications postoperative. This study attempted to compare the effects of tidal volume 6 mL kgbw and 10 mL kgbb kgbw against distribution of ventilation in kidney transplant donor patients who underwent laparoscopic nephrectomy using EIT.Method This randomized clinical trial conducted in the Surgical Center Installation RSUPN Cipto Mangunkusumo and operating room RSCM Kencana Jakarta against 30 kidney transplant donor patients who underwent laparoscopic nephrectomy. Subjects were randomized into two intervention groups mechanical ventilation with intraoperative tidal volume 6 mL kgbw and 10 mL kgbw. The hypothesis is distribution of ventilation tidal volume 6 mL kgbw is better than 10 mL kgbw. Parameter TIV, EELI global and regional and CR were taken from a monitor EIT PulmoVista 500 . Result The value of TIV between dependent and nondependent parts of lung statistically significant difference on postdesuflation supine position p 0,008 , where the tidal volume of6 mL kgbw indicates distribution of ventilation is not homogenous. The value of EELI global and regional tidal volume 10 mL kg is higher and meaningful statistically on lateral decubitus before insuflation p 0,005 . There is no meaningful difference in CR value the dependent and nondependent parts of lung .Conclusion Tidal volume 6 mL kgbw does not give a better distribution of ventilation compared with 10 mL kgbw in kidney donor patient undergoing laparoscopic nephrectomy based on the parameters of the EIT.Keywords Distribution of ventilation, EIT, kidney donor, laparoscopic nephrectomy, intraoperative volume tidal

Abstrak :
Praktik residensi keperawatan medikal bedah adalah program pendidikan yang bertujuan untuk menghasilkan perawat ners spesialis dengan kekhususan tertentu. Kegiatan praktik residensi terdiri dari pemberian asuhan keperawatan pada pasien dengan gangguan sistem perkemihan menggunakan pendekatan model adaptasi Roy. Asuhan keperawatan dilakukan kepada pasien dengan kasus gagal ginjal terminal, keganasan dan obstruksi. Penggunaan pendekatan teori Roy bertujuan untuk membantu meningkatkan adaptasi individu terhadap lingkungannya. Penerapan evidence based nursing yang berupa ice therapy bertujuan untuk mengurangi nyeri penusukan AV fistula pada pasien yang menjalani hemodialisis. Tindakan ini dapat digunakan sebagai salah satu intervensi manajemen nyeri non farmakologi karena efektif, sederhana dan tidak memiliki resiko. Pelaksanaan proyek inovasi berupa program ambulasi dini pada pasien transplantasi ginjal bertujuan untuk meningkatkan pengetahuan dan kemampuan pasien untuk melakukan ambulasi dini sehingga mempercepat lama rawat inap di rumah sakit

---

The residency practice of medical surgical nursing is an educational program that aims to produce nurse specialist with particular specialty. It consist of giving nursing care to patients with urinary system disorder using Roy's model adaptation. Nursing care during residency practice was given to patient with renal failure, malignancy and urinary tract obstruction. The using Roy adaptation model is aimed to improve patient adaptation with the environment. Implementation of evidence based nursing (EBN) using ice therapy is aimed to reduce pain cannulation AV fistula in patients undergoing hemodialysis. Ice therapy is simple, more effective, and without side effect so that it can be applied as non-pharmacological pain management intervention. The implementation of innovation project through early ambulation for kidney transplantation patient to increase knowledge and ability of patients to carry out early ambulation as to accelerate the length of stay hospital.

Abstrak :
Latar Belakang: TCI propofol dan sevofluran merupakan agen pemeliharaan anestesi umum yang sering digunakan, termasuk pada transplantasi ginjal dan memiliki pengaruh terhadap hemodinamik intra-operatif, khususnya kardiovaskular. Tujuan: Membandingkan pengaruh TCI propofol dan sevofluran terhadap profil hemodinamik kardiovaskular intra-operatif resipien transplantasi ginjal. Metode: Uji klinis prospektif tersamar tunggal terhadap 46 resipien transplantasi ginjal di RSCM selama bulan Juli-Desember 2017. Parameter hemodinamik diukur saat pasca-induksi, pasca-insisi, intra-operatif dan pascareperfusi. Hasil dianalisis menggunakan uji general linear model untuk pengukuran berulang, uji t tidak berpasangan Mann-Whitney U. Hasil: Indeks kardiak intra-operatif p = 0,216 , pasca-induksi 4,20 vs 3,10 L/mnt/m2, p = 0,056 dan pascareperfusi 4,77 vs 4,07 L/mnt/m2, p = 0,077 kelompok TCI propofol lebih tinggi dibandingkan sevofluran. Tekanan rerata arteri intra-operatif hampir sama pada kedua kelompok p = 0,480, nilai pasca-induksi 80,74 vs 80,61 mmHg, p = 0,980 dan pascareperfusi 89,30 vs 92,52 mmHg, p = 0,359 lebih tinggi pada kelompok sevofluran. Indeks volume sekuncup hampir sama pada kedua kelompok p = 0,086, dengan nilai pasca-induksi lebih tinggi 54,35 vs 49,56 mL/m2, p = 0,335 dan pascareperfusi lebih rendah 62,52 vs 62,78 mL/m2, p = 0,962 pada kelompok TCI propofol. Indeks resistensi vaskular sistemik intra-operatif p = 0,054, pasca-induksi 1786 vs 1426 dynes.detik/cm-5/m2, p = 0,077 dan pascareperfusi 1523 vs 1404 dynes.detik/cm-5/m2, p = 0,223 lebih tinggi pada kelompok sevofluran. Simpulan: Tidak terdapat perbedaan pengaruh hemodinamik yang signifikan secara statistik intra-operatif antara TCI propofol dengan sevofluran pada resipien transplantasi ginjal.

---

Background: TCI propofol and sevoflurane are common agents for general anesthesia, including for renal transplantation procedure. They have intraoperative hemodynamic effect, especially cardiovascular. Aim. Comparing the effect of TCI propofol and sevoflurane to intraoperative cardiovascular hemodynamic profile in renal transplant patients. Methods: Single blinded prospective study in 46 renal transplant patients at Cipto Mangunkusumo National Hospital between July-December 2017. Hemodynamic parameters were measured at postinduction, postincision, intraoperative, and postreperfusion. Data were analyzed using general linear model for repeated measurements, unpaired t-test, Mann-Whitney U. Results: Intraoperative cardiac index p = 0,216, postinduction 4,20 vs 3,10 L/mnt/m2, p = 0,056 and postreperfusion 4,77 vs 4,07 L/mnt/m2, p = 0,077 TCI propofol group were higher than sevoflurane group. Mean arterial pressure intraoperatively similar in both groups p = 0,480, postinduction 80,74 vs 80,61 mmHg, p = 0,980 and postreperfusion 89,30 vs 92,52 mmHg, p = 0,359 were higher in sevoflurane group. Stroke volume index were similar in both groups p = 0,086, and higher during postinduction 54,35 vs 49,56 mL/m2, p = 0,335 but lower during postreperfusion 62,52 vs 62,78 mL/m2, p = 0,962 TCI propofol group. Systemic vascular resistance index were higher during intraoperative p = 0,054, postinduction 1786 vs 1426 dynes.detik/cm-5/m2, p = 0,077 and postreperfusion 1523 vs 1404 dynes.detik/cm-5/m2, p = 0,223 in sevoflurane group. Conclusion: Intraoperative hemodynamic effects were statisticaly similar between TCI propofol and sevoflurane group in renal transplant recipients.