Kohei Kinoshita1, Shigeyoshi Yamanaga2, Akari Kaba3, Kosuke Tanaka3, Masatomo Ogata4, Mika Fujii4, Yuji Hidaka3, Chiaki Kawabata5, Mariko Toyoda5, Soichi Uekihara5, Masayuki Kashima4, Akira Miyata5, Akito Inadome6, Takaaki Kobayashi7, Hiroshi Yokomizo3. 1. Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan. 2. Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan. Electronic address: yamanaga@kumamoto-med.jrc.or.jp. 3. Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan. 4. Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan. 5. Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan. 6. Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan. 7. Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan.
Abstract
BACKGROUND: Adequate renal perfusion at the time of unclamping is important because it has been known to affect outcomes in renal transplantation. Nevertheless, the ideal intraoperative systolic arterial pressure (SAP) has not been well defined. METHODS: We performed a retrospective analysis of 106 living donor renal transplants performed at our center from June 2010 to May 2019. We divided the cohort into 2 groups according to our center's goal SAP of ≥150 mm Hg: 57 patients had SAP ≥150 mm Hg and 49 patients had SAP <150 mm Hg. We analyzed pretransplant characteristics, intraoperative measurements, and postoperative laboratory values to validate our center's target SAP at the time of reperfusion. This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor sources. RESULTS: Patients with SAP ≥150 mm Hg had been on dialysis for a significantly shorter duration before transplant compared with those who had SAP <150 mm Hg. In the SAP ≥150 mm Hg group, urinary sodium excretion normalized earlier, and they had a significantly smaller stroke volume variation, higher cardiac output and cardiac index, earlier initial urination, and higher intraoperative urine output. There were no differences in intraoperative volume repletion, central venous pressure, or postoperative estimated glomerular filtration rate. CONCLUSION: Achieving SAP ≥150 mm Hg at the time of reperfusion may be associated with early stabilization of graft function. Nevertheless, our data suggested that recipients with a prolonged dialysis history are less likely to achieve SAP ≥150 mm Hg at the time of unclamping in living donor renal transplantation.
BACKGROUND: Adequate renal perfusion at the time of unclamping is important because it has been known to affect outcomes in renal transplantation. Nevertheless, the ideal intraoperative systolic arterial pressure (SAP) has not been well defined. METHODS: We performed a retrospective analysis of 106 living donor renal transplants performed at our center from June 2010 to May 2019. We divided the cohort into 2 groups according to our center's goal SAP of ≥150 mm Hg: 57 patients had SAP ≥150 mm Hg and 49 patients had SAP <150 mm Hg. We analyzed pretransplant characteristics, intraoperative measurements, and postoperative laboratory values to validate our center's target SAP at the time of reperfusion. This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor sources. RESULTS:Patients with SAP ≥150 mm Hg had been on dialysis for a significantly shorter duration before transplant compared with those who had SAP <150 mm Hg. In the SAP ≥150 mm Hg group, urinary sodium excretion normalized earlier, and they had a significantly smaller stroke volume variation, higher cardiac output and cardiac index, earlier initial urination, and higher intraoperative urine output. There were no differences in intraoperative volume repletion, central venous pressure, or postoperative estimated glomerular filtration rate. CONCLUSION: Achieving SAP ≥150 mm Hg at the time of reperfusion may be associated with early stabilization of graft function. Nevertheless, our data suggested that recipients with a prolonged dialysis history are less likely to achieve SAP ≥150 mm Hg at the time of unclamping in living donor renal transplantation.
Authors: Robert Sucher; Tina Schiemanck; Hans Michael Hau; Sven Laudi; Sebastian Stehr; Elisabeth Sucher; Sebastian Rademacher; Daniel Seehofer; Nora Jahn Journal: J Clin Med Date: 2022-04-01 Impact factor: 4.241