Troisi Roberto I, Rompianesi Gianluca, Campanile Silvia, Eleftheriades Xenios, Rubba Fabiana, Cassese Gianluca, Caggiano Marcello, De Simone Giuseppe, Giglio Mariano C, Carrano Rosa, Bracale Umberto M, Montalti Roberto
Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
Department of Public Health, Federico II University, Naples, Italy.
Updates Surg. 2025 Aug 25. doi: 10.1007/s13304-025-02344-5.
Optimal graft perfusion is key to achieving satisfactory post-transplant function. The possibility of evaluating vascular flows can lead to the early identification of vascular complications and reflect graft quality and outcome. From 1, 2022 to 1, 2024, transit time flow measurements (TTFM) were prospectively recorded in 75 consecutive kidney transplants (KTx) and analyzed alongside donor, recipient, transplant, and outcome data. Correct measurements were obtained in all cases. Patients receiving living-donor transplants showed higher arterial TTFM (397 (251-532) vs. 295 (167-382) ml/min, p = 0.010) but similar venous TTFM (p = 0.512). Arterial TTFM presented an inverse correlation with donor BMI (r = - 0.241, 95% CI - 0.449-0.008, p = 0.037). Two patients (2.6%) with severely reduced TTFM (< 50 ml/min) developed intraoperative vascular complications and underwent immediate treatment. Patients experiencing delayed graft function (DGF) presented lower arterial and venous TTFM (200 (119-298) vs. 341 (267-448) ml/min, p < 0.001 and 222 (170-391) vs. 369 (272-456) ml/min, p = 0.015), respectively. In patients with higher arterial TTFM, the serum creatinine levels showed a faster decrease (r = - 0.493, 95% CI - 0.652-0.293, p < 0.001). Arterial TTFM (OR: 0.993 (0.989-0.998), p = 0.004) and donor arterial hypertension (OR: 9.292 (2.337-36.935), p = 0.002) resulted in independent risk factors for DGF development at the multivariable logistic regression analysis. The identified arterial cutoff for better outcomes was 310 ml/min (AUROC 0.765). The intraoperative TTFM evaluation in KTx was safe and effective in the early recognition of vascular complications. Arterial TTFM reflect graft quality, with lower flows (< 310 ml/min) correlating with slower post-transplant serum creatinine decrement and representing an independent risk factor for DGF development.
最佳移植物灌注是实现满意移植后功能的关键。评估血管血流的可能性可导致早期识别血管并发症，并反映移植物质量和结果。2022年1月至2024年1月，对75例连续肾移植（KTx）患者进行了前瞻性记录的通过时间血流测量（TTFM），并与供体、受体、移植及结果数据一起进行分析。所有病例均获得了正确测量值。接受活体供体移植的患者动脉TTFM较高（397（251 - 532）对295（167 - 382）ml/min，p = 0.010），但静脉TTFM相似（p = 0.512）。动脉TTFM与供体BMI呈负相关（r = - 0.241，95%CI - 0.449 - 0.008，p = 0.037）。两名患者（2.6%）TTFM严重降低（< 50 ml/min），术中出现血管并发症并接受了立即治疗。发生移植肾功能延迟（DGF）的患者动脉和静脉TTFM较低（分别为200（119 - 298）对341（267 - 448）ml/min，p < 0.001和222（170 - 391）对369（272 - 456）ml/min，p = 0.015）。在动脉TTFM较高的患者中，血清肌酐水平下降更快（r = - 0.493，95%CI - 0.652 - 0.293，p < 0.001）。在多变量逻辑回归分析中，动脉TTFM（OR：0.993（0.989 - 0.998），p = 0.004）和供体动脉高血压（OR：9.292（2.337 - 36.935），p = 0.002）是DGF发生的独立危险因素。确定的更好结果的动脉临界值为310 ml/min（AUROC 0.765）。KTx术中TTFM评估在早期识别血管并发症方面是安全有效的。动脉TTFM反映移植物质量，较低的血流（< 310 ml/min）与移植后血清肌酐下降较慢相关，并是DGF发生的独立危险因素。
