Sucher Robert, Schiemanck Tina, Hau Hans Michael, Laudi Sven, Stehr Sebastian, Sucher Elisabeth, Rademacher Sebastian, Seehofer Daniel, Jahn Nora
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany.
J Clin Med. 2022 Apr 1;11(7):1966. doi: 10.3390/jcm11071966.
Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas−kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1−10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0−4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.
在同期胰肾联合移植（SPKT）中，充分的器官灌注以及开放血管夹时适当的血压水平对于早期和长期移植物功能及预后至关重要。然而，术中最佳平均动脉压（MAP）水平尚未明确界定。方法：从一个前瞻性收集的数据库中，回顾性分析了在我们中心接受SPKT的105例患者的医疗数据。初步进行了受试者工作特征（ROC）分析，以确定再灌注时MAP的最佳截断值，从而预测早期胰腺移植物功能。基于这些结果，我们根据再灌注时的MAP值将患者分为<91 mmHg组（n = 47例患者）和>91 mmHg组（n = 58例患者）。回顾性分析了临床病理特征、预后以及早期移植物功能和长期生存情况。结果：两组间供体和受体特征具有可比性。<91 mmHg组术后并发症发生率显著高于>91 mmHg组（胰腺血管血栓形成：7例（14%）对2例（3%）；p = 0.03；胰腺炎/腹腔内脓肿：10例（21%）对4例（7%）；p = 0.03；肾移植延迟功能恢复（DGF）：11例（23%）对5例（9%）；p = 0.03；再灌注后尿量：106±50 mL对195±45 mL；p = 0.04）。术中液体补充量、中心静脉压（CVP）、血管活性正性肌力药物的使用以及代谢结果方面无显著差异。>91 mmHg组的5年胰腺移植物存活率显著更高（>91 mmHg组：82%对<91 mmHg组：61%；p < 0.01）。两组间5年患者和肾移植物存活率无显著差异。多因素Cox回归分析确认MAP < 91 mmHg是肾DGF（HR 3.49，1.1 - 10.8，p = 0.03）和胰腺同种异体移植失败（HR 2.26，1.0 - 4.8，p = 0.01）的独立预后预测指标。结论：再灌注时MAP > 91 mmHg与术后并发症发生率降低相关，可改善和恢复长期移植物功能及预后，从而提高SPKT受者的长期生存率。
