Korean J Transplant.  2020 Dec;34(Supple 1):S99. 10.4285/ATW2020.PO-1098.

Effect of preoperative dialysis on intraoperative hemodynamics during living donor kidney transplantation

• Kim KA
• Lee K
• Kim G
• Kang H
• Yang J

• KMID: 2509247
• DOI: http://doi.org/10.4285/ATW2020.PO-1098

Abstract

Background
End-stage renal disease patients on dialysis typically have an advanced disease status and many cardiovascular complications. We aimed to compare the intraoperative hemodynamics between non-preemptive (with preoperative dialysis) and preemptive (without preoperative dialysis) recipients of living donor kidney transplantation (LDKT).
Methods
This was a single center retrospective study. The recipients of LDKT were included and all data were collected by electronic medical record. Recipients were divided in two groups: preemptive and non-preemptive kidney transplantation. After comparing the potential risk factors between two groups, we performed a propensity score-matching analysis to reduce the differences of baseline characteristics. The primary outcome was intraoperative hemodynamic events such as the prevalence of the intraoperative hypotension; electrolyte; frequency of inotropes or vasopressors use; and acid-base status. Secondary outcome was immediate graft function by nadir creatinine (Cr), time to nadir Cr. Estimated blood loss, surgical time, postoperative bleeding and re-operation were also investigated.
Results
We analyzed data from 541 patients after propensity score matching: 388 and 153 patients in non-preemptive and preemptive groups, respectively. The multivariable analysis revealed the AUT of the preemptive group was significantly greater than those of non-preemptive group at thresholds absolute 70 and more inotropes and vasopressors were administered to the preemptive group. Furthermore, base excess in the preemptive group was lower than non-preemptive group. Postoperative nadir Cr concentration, the time to nadir Cr were not different between two groups significantly. Estimated blood loss, surgical time, postoperative bleeding, re-operation were also not different between two groups.
Conclusions
Intraoperative hypotension and acidosis occurred more frequently in recipients without preoperative dialysis during LDKT. With this finding in mind, anesthesiologists should prepare for situations where intraoperative hypotension may occur.