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Paediatr Anaesth. 2017 Sep;27(9):927-934. doi: 10.1111/pan.13201. Epub 2017 Jul 24.

Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation.

Author information

1
Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
2
Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.
3
Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.
4
Anesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.
5
Department of general and urological surgery, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
6
DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France.
7
Departement of Paediatric Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.

Abstract

BACKGROUND:

The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function.

METHODS:

We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure. The main outcome of the study was the creatinine clearance at day 1 corrected to a body surface area of 1.73 m². Analysis was performed using Classification Tree Analysis with 10-fold cross-validation.

RESULTS:

One hundred and two patients were included. The following predictors of increased postoperative creatinine clearance at day 1 were identified: decreasing recipient weight, mean blood pressure-to-weight ratio 10 minutes after reperfusion, reduced cold ischemia duration, and increased intraoperative albumin infusion. Increased creatinine clearance was observed when mean blood pressure-to-weight ratio 10 minutes after reperfusion was ≥4.3 in patients weighing 13-21 kg and ≥2.5 in those ≥22 kg. Overall, the model explained 64% (and at cross-validation 60%) of creatinine clearance variability at day 1.

CONCLUSION:

Intraoperative hemodynamics during kidney transplantation should be optimized in order to increase mean blood pressure according to values indicated by our analyses. Cold ischemia duration should be shortened as far as possible.

KEYWORDS:

children; kidney; renal function; transplantation

PMID:
28736994
DOI:
10.1111/pan.13201
[Indexed for MEDLINE]

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