Published online Apr 18, 2021. doi: 10.5500/wjt.v11.i4.114
Peer-review started: November 23, 2020
First decision: January 25, 2021
Revised: February 5, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: April 18, 2021
Processing time: 135 Days and 14 Hours
There is a profound need to increase the availability of deceased donor kidney transplantation (DDKT) to address the high incidence of kidney failure. However, challenges exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients; thus the identification of modifiable risk factors associated with poor outcomes is paramount.
Higher-risk kidney allografts more frequently exhibit delayed graft function (DGF), which has previously been associated with adverse outcomes such as acute rejection, chronic allograft nephropathy, shorter allograft survival, and increased costs. Furthermore, prior studies have pointed to an association between recipients’ blood pressure and the occurrence of DGF but have conflicted on the clinical setting and unique patient characteristics that may predispose to it.
A clear need exists for the identification and optimization of modifiable perioperative risk factors associated with DGF. We aim to identify risk factors associated with DGF, with a particular focus on perioperative hemodynamic factors, since these can be more readily optimized to improve graft and patient outcomes.
Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 patients. All donor data and recipients’ demographic, comorbidities, preoperative medications, and echocardiographic data within one year prior to transplant, as well as laboratory evaluation upon admission and intraoperative data were recorded. The primary outcome was the occurrence of DGF.
The incidence of DGF was 27%. Under logistic regression, eight independent risk factors for DGF were identified including recipient body mass index ≥ 30 kg/m2, baseline mean arterial pressure < 110 mmHg, intraoperative phenylephrine administration, cold storage time ≥ 16 h, donation after cardiac death, donor history of coronary artery disease, donor terminal creatinine ≥ 1.9 mg/dL, and a hypothermic machine perfusion (HMP) pump resistance ≥ 0.23 mmHg/mL/min.
We delineate the association between DGF and recipient characteristics of pre-induction MAP below 110 mmHg, metabolic syndrome, donor-specific risk factors, HMP pump parameters, and intraoperative use of phenylephrine.
Future studies with larger multicenter cohorts are needed to further explore means to improve outcomes of recipients with suboptimal baseline or intraoperative blood pressure.