Transoperative Hemodynamic Status and Delayed Graft Function: Analysis of 42 Consecutive Renal Transplantation

Pimpao, Bruno de Figueiredo; Hokazono, Silvia Regina; Ruani, Tiago Ormelez; Santos, Vital Burko; Meyer, Fernando; Fraga, Rogerio de

doi:10.53855/bjt.v26i1.494_ENG

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Brazilian Journal of Transplantation

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ORIGINAL PAPER • Braz. J. Transplant. 26 • 2023 • https://doi.org/10.53855/bjt.v26i1.494_ENG copy

Transoperative Hemodynamic Status and Delayed Graft Function: Analysis of 42 Consecutive Renal Transplantation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Evaluate the correlation between transoperative hemodynamic status and development of delayed graft function (DGF) in patients undergoing kidney transplantation.

Methods:

We analyzed 42 consecutive renal transplants between May 2021 and May 2022 in a University Hospital. Four kinds of variables were assessed. Recipients variables: age, gender, race, type of dialysis, dialysis time before transplantation and residual diuresis. Donor variables: age, serum creatinine level, death cause, race, laterality of the kidney (right or left kidney), perfusion solution and Kidney Donor Profile Index (KDPI). Surgical variables: cold Ischemia time (CIT), vascular multiplicity, the surgeon, duration of surgery and blood pressure during the procedure. Immunological variables: Panel reactive antibodies (PRA), HLA mismatches and the need of induction therapy with antithymocyte globulin.

Results:

In univariate analysis, regarding recipients’ factors, type of dialysis (hemodyalisis) (p=0.004) and absence of residual diuresis (p=0.011) were significant on the development of DGF. Among the donors, only the laterality of the kidney (right kidney) was statiscally significant (p=0.005). The cold ischemia time higher than 24 hours (p=0.022), systolic blood pressure (SBP) less than 130 mmHg at reperfusion (p<0.001), Mean Arterial Pressure (MAP) less than 80 mmHg at the reperfusion (p<0.001), and mean MAP post-reperfusion (p=0.049) were the significant surgical factors for DGF. Among immunological factors, the patients that received antithymocyte globulin as induction therapy more frequently developed DGF (p=0.036). Only MAP < 80 mmHg (p=0.004) and SBP < 130m mmHg (p=0.005) were independent risk factors for DGF.

Conclusion:

In this survey, optimal renal perfusion, avoiding fall in blood pressure in the transoperative period, especially after graft reperfusion, is crucial for the immediate functioning of the kidney.

Keywords
Kidney Transplantation; Delayed Graft Function; Risk Factors; Hemodynamics

		n=37
Recipients
Age (Years)		49.5 (20-75)
Male Gender		61.5%
White Race		71.8%
Type of Dialysis
	PD	34.2%
	HD	55.3%
	Preemptive	10.5%
Base disease
	Diabetes	36.9%
	Hypertension	21.1%
	Glomerulonephritis	21.1%
	Others	21.1%
Dialysis time before transplantation (months)		18.5
Residual diuresis		84.2%
Donors
Age		44 (10-65)
Creatinine level (mg/dl)		0.91 (0.3 - 1.8)
White race		76.3%
Cause of Death
	Stroke	51.4%
	Head Trauma	39.5%
	Others	9.2%
Right Kidney		45.9%
Perfusion solution
	Custodiol	86.5%
	Euro-Collins	4.5%
	IGL-1	9%
KDPI		46% (4-83%)
Surgery
CIT (minutes)		1217 (788 - 2118)
Vessel multiplicity		32.4%
Surgeon
	A	13.5%
	B	43.2%
	C	29.8%
	D	13.5%
Duration of Surgery (minutes)		228 (165-300)
Base SBP (mmHg)		165 (104 - 252)
Reperfusion SBP (mmHg)		122 (70 - 155)
Base MAP (mmHg)		115 (69 - 170)
Reperfusion MAP (mmHg)		86 (50 - 108)
DGF		56%
Immunity
PRA		11% (0-92%)
MM		3.76 (1-5)
ATG		23.1%

		IGF (n=16)	DGF (n=21)	Test	p Value
Recipients Factors
	Age (Years)	53.18±15.65	45.95±16.17	T-Student	0.09
	Male Gender	8 (50%)	7 (33.3%)	Chi-Square	0.306
	White Race	11 (73.3%)	15 (71.4%)	Chi-Square	0.571
	Type of Dyalisis (HD, PD, PE).	7 / 4 / 4	4 / 17 / 0	Chi-Square	0.004
	Dyalisis before transplantation (months)	15.57 15.90	20.57 15.14	Mann-Whitney	0.351
	Residual Diuresis	15 (93.7%)	15 (71.4%)	Chi-Square	0.011
Donor Factors
	Age (Years)	38.78± 16.42	47.14± 14.59	Mann-Whitney	0.162
	Creatinine (mg/dl)	0.9± 0.25	0.88± 0.33	T-Student	0.141
	White Race	12 (85.7%)	16 (76.1%)	Chi-Square	0.192
	Death Cause (Stroke / Head trauma / Others)	2 / 8 / 3	13 / 7 / 1	Chi-Square	0.119
	Right Kidney	3 (21.4%)	14 (66.6%)	Chi-Square	0.005
	Perfusion Solution (Custodiol, Collins, IGL-1)	8 / 1 / 0	10 / 0 /2	Chi-Square	0.266
	KDPI	35.9± 30.88	53.65± 25.14	Mann-Whitney	0.156
Surgery Factors
	CIT > 24h	4 (33.3%)	9 (75%)	Chi-Square	0.022
	CIT (minutes)	1160.83± 495.07	1283.42 ±451.42	Mann-Whitney	0.244
	Surgeon (A / B / C / D)	3 / 4 / 5 / 2	2 / 10 / 6 / 3	Chi-Square	0.263
	Vessel multiplicity	5 (35.7%)	7 (33.3%)	Chi-Square	0.172
	Duration of Surgery (min)	221.79± 36.82	236.25± 40.43	T-Student	0.157
	SBP <130mmHG at Repefusion	3(21.4%)	15(83.3%)	Chi-Square	<0.001
	MAP <80 at reperfusion (mmHG)	1 (7.1%)	11(61.1%)	Chi-Square	<0.001
	SBP at Reperfusion (mmHG)	133.07± 15.80	114.61± 17.65	T-Student	0.002
	Mean MAP Post-Reperfusion (mmHG)	91.05± 9.45	84.53± 11.31	T-Student	0.049
Immunological factors
	PRA	15± 31.57	5± 18.5	Mann-Whitney	0.35
	MM	3.66±1.23	3.85± 1.15	Mann-Whitney	0.776
	ATG	1 (6.2%)	7 (33.3%)	Chi-Square	0.036

	Chi-Square	Beta Value	p Value
MAP < 80 mmHg at Reperfusion	8.344	-43.688	0.004
SBP < 130 mmHg at Reperfusion	8.052	-22.468	0.005
ATG	3.833	20.733	0.05
Mean MAP Post-Reperfusion (mm Hg)	1.743	-0.218	0.187
CIT > 24h	0.622	-1.753	0.43
Residual Diuresis	0	2.516	0.996

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E-mail: abto@abto.org.br

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[1] * Correspondence author: brunopimpao@hotmail.com