Intraoperative Hemodynamic Parameters Associated With Delayed Graft Function in Kidney Transplant Patients

Purpose: Intraoperative hemodynamic instability was proven to be associated with delayed graft function (DGF) after kidney transplantation. This retrospective study aims to find the specific intraoperative hemodynamic parameters as an efficient predicting factor of DGF.

Materials and methods: Patients who underwent kidney transplantation between 2020 and 2022 were enrolled and classified into DGF and non-DGF groups. Pediatric and multiorgan recipients were excluded. Hemodynamic parameters such as central venous pressure, mean arterial pressure, cardiac output, and cardiac index (CI) at the timings of wound incision, graft reperfusion, and operation completion were recorded, respectively. A comparison of parameters between these 2 groups was analyzed.

Results: We enrolled 42 recipients, with 26 in the DGF group and 16 in the non-DGF group. Compared with the DGF group, CI around graft reperfusion was significantly higher in the non-DGF group (3.97 vs 4.67 L/min/m², P = .043). Other hemodynamic variables revealed no statistical difference. In the results of multivariate analysis, the deceased donor source, the greater volume of blood loss, and the lower CI around graft reperfusion were considered independent risk factors for DGF. Using CI around graft reperfusion to conduct a receiver operating characteristic (ROC) curve for DGF prediction, the area under the ROC curve achieved a value of 0.739 (95% confidence interval, 0.579-0.900), with the optimal cut-point value at CI = 4.245 L/min/m².

Conclusion: The cardiac index value around graft reperfusion was statistically associated with the incidence of DGF and might be used as a valid predicting factor.