Morrison Steven A, Thanamayooran Aran, Tennankore Karthik, Vinson Amanda J
Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Kidney Int Rep. 2025 Apr 1;10(6):1819-1828. doi: 10.1016/j.ekir.2025.03.055. eCollection 2025 Jun.
The impact of perioperative hypotension on graft function after kidney transplantation (KT) has not been well-described; however, it may be expected to negatively impact posttransplant outcomes.
We conducted a retrospective cohort study of adult patients undergoing KT in a multiprovincial renal program from 2006 to 2019. Using multivariable logistic regression, we assessed the association of intraoperative hypotension (IOH; systolic blood pressure (sBP) ≤ 90 mm Hg within the final hour of surgery) and postoperative hypotension (POH; occurring within the first 2 postoperative days) with delayed graft function (DGF). In secondary analyses, we used adjusted logistic regression or Cox proportional hazards models to assess the impact of hypotension on prolonged length of stay (LOS), death-censored graft loss (DCGL), and all-cause graft loss (ACGL).
Of the 1020 patients included, 209 (20.5%) and 112 (11.0%) had IOH and POH, respectively. POH was associated with DGF (adjusted odds ratio [aOR]: 4.01, 95% CI: 2.24-7.19), LOS (aOR: 2.82, 95% CI: 1.69-4.71), DCGL (adjusted hazard ratio [aHR]: 3.37, 95% CI: 1.29-8.84), and ACGL (aHR: 2.21, 95% CI: 1.26-3.89). IOH was not associated with DGF (aOR: 1.02, 95% CI: 0.61-1.72) or LOS (aOR: 1.19, 95% CI: 0.81-1.76), but was associated with reduced DCGL (aHR: 0.32, 95% CI: 0.13-0.82) and ACGL (aHR: 0.59, 95% CI: 0.36-0.98). There was a trend toward greater susceptibility to POH in male than female recipients; however, this did not meet statistical significance.
Overall, POH, but not IOH, was associated with an increased risk of DGF, prolonged LOS, DCGL, and ACGL.
围手术期低血压对肾移植（KT）后移植肾功能的影响尚未得到充分描述；然而，可以预期它会对移植后结果产生负面影响。
我们对2006年至2019年在一个多省肾脏项目中接受KT的成年患者进行了一项回顾性队列研究。使用多变量逻辑回归，我们评估了术中低血压（IOH；手术最后一小时内收缩压（sBP）≤90 mmHg）和术后低血压（POH；术后前两天内发生）与移植肾功能延迟恢复（DGF）之间的关联。在二次分析中，我们使用调整后的逻辑回归或Cox比例风险模型来评估低血压对住院时间延长（LOS）、死亡删失移植丢失（DCGL）和全因移植丢失（ACGL）的影响。
在纳入的1020例患者中，分别有209例（20.5%）和112例（11.0%）发生了IOH和POH。POH与DGF（调整后的优势比[aOR]：4.01，95%置信区间[CI]：2.24 - 7.19）、LOS（aOR：2.82，95% CI：1.69 - 4.71）、DCGL（调整后的风险比[aHR]：3.37，95% CI：1.29 - 8.84）和ACGL（aHR：2.21，95% CI：1.26 - 3.89）相关。IOH与DGF（aOR：1.02，95% CI：0.61 - 1.72）或LOS（aOR：1.19，95% CI：0.81 - 1.76）无关，但与DCGL降低（aHR：0.32，95% CI：0.13 - 0.82）和ACGL降低（aHR：0.59，95% CI：0.36 - 0.98）相关。男性受者比女性受者对POH的易感性有增加的趋势；然而，这未达到统计学显著性。
总体而言，POH而非IOH与DGF风险增加、LOS延长、DCGL和ACGL相关。
