Odstranjivanje tuneliranoga središnjeg venskog katetera nakon bubrežne presadbe

Karlo Kurtov, Branislav Čingel, Željka Jureković, Bojana Maksimović, Ivan Margeta, Snježana Šulc, Bojana Šimunov, Ksenija Vučur Šimić, Lada Zibar

Cilj istraživanja: Predstaviti iskustva našega transplantacijskog središta vezano za odstranjivanje tuneliranoga dijaliznog katetera (TDK) nakon bubrežne presadbe (TX, od engl. transplantation). Optimalno vrijeme uklanjanja TDK-a nakon TX-a nije poznato. Ispitanici i postupci: U 41 bolesnika (24 muška, medijan dobi 60 godina, 30 – 73) učinjeno je odstranjivanje TDK-a nakon TX-a (izolirano bubreg ili simultano s gušteračom ili jetrom) od 1. srpnja 2018. do 30. lipnja 2023. (tri od živog darovatelja, ostalo od preminulih). Ukupan broj bolesnika s TDK-om zbog provođenja hemodijalize (HD) u vrijeme TX-a među ukupno 249 bolesnika kojima je u opisanom razdoblju učinjen TX u našem središtu bio je 41 (16,5%). Vrijeme odstranjivanja planirano je nakon prve protokolarne biopsije bubrega dva mjeseca nakon TX-a, a odluka je temeljena na rezultatima biopsije i stabilnoj funkciji presatka. Kateter je odstranjen standardnim postupkom, a pacijent je otpušten nekoliko sati poslije u slučaju izostanka razvoja komplikacija. Rezultati: Trideset i sedam bolesnika imalo je Hickmanov, a četiri Tesio tip TDK-a, njih dvadeset i devet smješten u desnoj, osam u lijevoj unutarnjoj jugularnoj veni, tri u desnoj potključnoj veni, te jedan u lijevoj femoralnoj veni. Medijan vremena odstranjivanja TDK-a nakon TX-a (n = 36) bio je četiri mjeseca (1 – 14, interkvartilni raspon 2 – 5). Kaplan-Meierova analiza s pet cenzoriranih slučajeva koji još uvijek čekaju odstranjenje TDK-a pokazala je medijan vremena od TX-a do uklanjanja TDK-a od četiri mjeseca, 95% intervali pouzdanosti 3,249 – 4,751. Jedan bolesnik imao je znakove infekcije tunela, a jedno odstranjivanje učinjeno je zbog sepse koja nije bila povezana s kateterom. Tri bolesnika su imala neuspjeh pri prvom odstranjivanju katetera, a jedan je imao umjereno poslijeproceduralno krvarenje. Zaključci: Iskustvo našeg središta pokazuje sigurnost u pristupu uklanjanja TDK-a tri do pet mjeseci nakon TX-a, s malim rizikom infekcije i krvarenja.

Aim: To present the experience of our kidney transplantation (TX) center regarding removing tunneled central venous catheter (CVC) after kidney TX. The optimal timing of CVC removal has not been known yet. Patients and methods: Forty-one patients (24 males, median age 60 years, 30 – 73) underwent removal of tunneled CVC after TX (kidney only or combined with pancreas or liver) from July 1st, 2018 to June 30th, 2023 (3 living donors, others deceased). The total number of patients that had tunneled CVC for hemodialysis (HD) at the time of TX among 249 patients who underwent TX at our center during that period was 41 (16.5 %). The timing was planned after the first protocol kidney transplant biopsy performed 2 months after the TX, and the decision was based on the biopsy findings and stable kidney graft function. The catheter was removed using standard procedure, and the patient was discharged several hours thereafter if no complications had occurred. Results: Thirty-seven patients had Hickman while four had Tesio type of CVC, 29 placed in the right, eight in the left internal jugular vein, three in the right subclavian vein, and one in the left femoral vein. The median time of removal after TX (n = 36) was four months (1 – 14, interquartile range 2 – 5). Kaplan-Meier analysis with five
censored cases who were still waiting for removal showed a median time from TX to CVC removal of four months, 95% confidence interval 3.249 – 4.751. One patient had signs of tunnel infection and in one the removal was done due to non-catheter related sepsis. Three patients had unsuccessful first attempt of the removal, while one patient experienced moderate bleeding. Conclusion: Experience at our center showed the safety of the approach to remove tunneled CVC 3 – 5 months after kidney TX, with low infection and low bleeding risk.