J. Schutt Ryan, Case Jamie, Barrick Bethany, E. Toll Alice, L. Schaffer Randolph, S. Fisher Jonathan, C. Rice James, L. Marsh Christopher, Living Kidney Transplant: The Influence of Intra-Operative Hemodynamics on Delayed Graft Function, Journal of Organ Transplantation, Volume 1, Issue 2, 2017, Pages 1-11, ISSN 2576-9359, https://doi.org/10.14302/issn.2576-9359.jot-17-1807.
(https://oap-researcharticles.org/jot/article/646)
Abstract: Purpose Intra-operative insults may subject living kidney transplants to poor outcomes. Therefore, we investigated whether intra-operative recipient and donor hemodynamics could act as predictors of delayed graft function and subsequent outcomes. Materials and Methods Living kidney donors and recipients from 2010-2016 at this institution underwent a retrospective chart review. Graft function by post-operative day 7 was used to classify recipients as delayed graft function (need for dialysis), slow graft function (creatinine > 2.5) and good function. Groups were analyzed for intra-operative hemodynamic differences and at one year, incidence of rejection, graft function and survival were compared. Results A total of 111 living renal transplants were performed. Average recipient age was 50 and just over halfwere male (53%). 9% (n=10) and 10% (n=11) developed delayed graft function and slow graft function, respectively. Minimum recipient post re-perfusion central venous pressure ≥12 mmHg was associated with poor graft function (delayed graft function/slow graft function/good function=67%/56%/24%, p=0.009), while intra-operative hypotension (systolic <90 mmHg or diastolic <50 mmHg) was not. Delayed graft function and slow graft function had higher incidences of rejection than good function (30% and 36% vs 9%, p=0.012). Graft function and survival were similar. One patient died with a functioning graft. Conclusions This single center retrospective study suggests that a post re-perfusion central venous pressure ≥12 mmHg is associated with delayed graft function.
Keywords: living kidney transplant; delayed graft function; slow graft function; central venous pressure; hemodynamics