肾移植术中平均动脉压与术后延迟肾功能：评估三种常用阈值。

Intraoperative Mean Arterial Pressure and Postoperative Delayed Graft Function in Kidney Transplantation: Evaluating Three Commonly Used Thresholds.

机构信息

Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA, Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

Department of Anesthesiology, Rajavithi Hospital, Bangkok, Thailand.

出版信息

Clin Transplant. 2024 Sep;38(9):e15458. doi: 10.1111/ctr.15458.

DOI:10.1111/ctr.15458

PMID:39302234

Abstract

BACKGROUND

Delayed graft function (DGF) is a common early complication after kidney transplantation (KT) and is associated with various long-term adverse outcomes. Despite numerous studies on hemodynamic management, the optimal hemodynamic goals during KT remain unclear. In this retrospective study, we aimed to investigate if three mean artery pressure (MAP) thresholds (≤75, 80, and 85 mmHg) that were commonly used in clinical practice were associated with DGF in adult patients undergoing KT.

METHODS

We extracted de-identified data on adult patients who underwent deceased donor KT from our Discovery Data Repository. DGF was defined as the requirement for dialysis within the first 7 days after transplantation. Three MAP thresholds (≤75, 80, and 85 mmHg) and the duration of pressure below the three thresholds were recorded. Multivariable logistic analysis was used to identify risk factors for DGF.

RESULTS

We included 2301 adult KT patients. The mean age was 52.5±12.9 years and 59% were male. DGF occurred in 1066 patients (46.3%). Patients frequently experienced MAP ≤75, 80, and 85 mmHg (approximately 70%, 80%, and 90% of patients experienced 10 min of MAP ≤75, 80, and 85 mmHg, respectively). Patients with DGF spent significantly longer durations below the three MAP thresholds during surgery compared with those without DGF. Further analysis revealed that the minimal time spent on MAP ≤75, 80, and 85 mmHg that were significantly associated with DGF were 6, 23, and 37 min, respectively. After adjusting for non-hemodynamic risk factors (age, basiliximab administration, and urine output), prolonged exposure to the three MAP thresholds remained significant predictors for DGF (for MAP ≤75 mmHg, OR 1.257, 95% CI 1.017-1.554, p = 0.034; MAP ≤80 mmHg, OR 1.220, 95% CI 1.018-1.463, p = 0.031; MAP ≤85 mmHg, OR 1.253, 95% CI 1.048-1.498, p = 0.013).

CONCLUSION

Prolonged exposure to the three common MAP thresholds (≤75, 80, and 85 mmHg) occurred frequently during adult deceased donor KT and was associated with DGF.

摘要

背景

延迟肾功能恢复（DGF）是肾移植（KT）后常见的早期并发症，与各种长期不良结局相关。尽管有许多关于血流动力学管理的研究，但 KT 期间的最佳血流动力学目标仍不清楚。在这项回顾性研究中，我们旨在研究在接受 KT 的成人患者中，三种常用的平均动脉压（MAP）阈值（≤75、80 和 85mmHg）是否与 DGF 相关。

方法

我们从我们的 Discovery Data Repository 中提取了接受已故供体 KT 的成人患者的去识别数据。DGF 定义为移植后 7 天内需要透析。记录了三个 MAP 阈值（≤75、80 和 85mmHg）和低于三个阈值的持续时间。多变量逻辑分析用于确定 DGF 的危险因素。

结果

我们纳入了 2301 名接受 KT 的成年患者。平均年龄为 52.5±12.9 岁，59%为男性。1066 名患者（46.3%）发生 DGF。患者经常经历 MAP≤75、80 和 85mmHg（大约 70%、80%和 90%的患者经历了 10 分钟的 MAP≤75、80 和 85mmHg）。与无 DGF 的患者相比，DGF 患者在手术期间低于三个 MAP 阈值的持续时间明显更长。进一步分析显示，与 DGF 显著相关的 MAP≤75、80 和 85mmHg 的最小持续时间分别为 6、23 和 37 分钟。在校正非血流动力学危险因素（年龄、巴利昔单抗给药和尿量）后，长时间暴露于三个 MAP 阈值仍然是 DGF 的显著预测因素（对于 MAP≤75mmHg，OR 1.257，95%CI 1.017-1.554，p=0.034；MAP≤80mmHg，OR 1.220，95%CI 1.018-1.463，p=0.031；MAP≤85mmHg，OR 1.253，95%CI 1.048-1.498，p=0.013）。