Association of Intraoperative Hypotension With Delayed Graft Function Following Kidney Transplant: A Single Centre Retrospective Cohort Study

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-10-26 DOI:10.1111/ctr.70000

Marc Sicova, Ryan McGinn, Sophia Emerson, Paula Perez, Roberto Gonzalez, Yanhong Li, Olusegum Famure, Ian Randall, Daniel Santa Mina, Michael Santema, Duminda N. Wijeysundera, Wilton Van Klei, S. Joseph Kim, Stuart A. McCluskey

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Abstract

Background

Intraoperative hypotension is associated with acute kidney injury after surgery. However, the definition (duration and magnitude) of hypotension during kidney transplantation (KT) surgery on early graft function remains unclear.

Methods

We conducted a retrospective cohort study of KT recipients from December 1, 2009, to December 31, 2019. Exposure to intraoperative hypotension was characterized as the duration (minutes) of mean arterial pressure (MAP) <55, <65, <75, and <85 mmHg. Our co-primary outcomes were DGF-creatinine reduction ratio (DGF-CRR, <30% creatinine reduction, postoperative days 1 and 2), and DGF-dialysis (DGF-D, required dialysis within the week of KT for deceased donor recipients). Logistic regression models were fitted to assess this relationship between MAP and DGF.

Results

We included 1602 KT (939 deceased donors, 663 living donors) and 23 were excluded. DGF-CRR occurred in 33% of patients. DGF-CRR was associated with MAP < 65 (>5 min: OR 1.77, 95% confidence interval [CI]: 1.39–2.30; 6–10 min: OR 1.67, 95% CI: 0.97–2.86; 11–20 min: OR 2.18, 95% CI: 1.31–3.63) in unadjusted and <55 mmHg (5 min: OR 1.85, 95% CI: 1.47–2.32; 5–10 min: OR 2.41, 95% CI: 1.65–3.53; 11–20 min: OR 2.36, 95% CI: 1.60, 3.48) in adjusted models. There was also a signal for increased risk of DGF-CRR at MAP < 75 (>5 min: OR 1.69, 95% CI: 1.02–2.80). DGF-D (incidence 35%) in deceased donor KT was not associated with hypotension.

Conclusions

We found an association between intraoperative hypotension and DGF-CRR at a threshold MAP of 55 mmHg, with a consistent signal toward increased risk at both 65 and 75 mmHg, as indicated by unadjusted models.

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术中低血压与肾移植后移植物功能延迟的关系：单中心回顾性队列研究

背景：术中低血压与术后急性肾损伤有关。然而，肾移植（KT）手术期间低血压对早期移植物功能的定义（持续时间和程度）仍不清楚：我们对 2009 年 12 月 1 日至 2019 年 12 月 31 日的 KT 受者进行了一项回顾性队列研究。术中低血压暴露的特征是平均动脉压（MAP）持续时间（分钟）：我们纳入了 1602 名 KT（939 名已故捐献者，663 名在世捐献者），其中 23 人被排除在外。33%的患者发生了 DGF-CRR。DGF-CRR 与 5 分钟 MAP 相关：OR 1.77，95% 置信区间 [CI]：在未经调整的情况下，DGF-CRR 与 MAP 相关（5 分钟：OR 1.77，95% 置信区间 [CI]：1.39-2.30；6-10 分钟：OR 1.67，95% CI：0.97-2.86；11-20 分钟：OR 2.18，95% CI：1.31-3.63）；5 分钟：OR 1.69，95% CI：1.02-2.80）。已故供体 KT 中的 DGF-D（发生率为 35%）与低血压无关：我们发现术中低血压与 DGF-CRR 之间存在关联，阈值 MAP 为 55 mmHg，未调整模型显示 65 mmHg 和 75 mmHg 时风险增加的信号一致。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.