Impact of intraoperative desmopressin on postoperative urine output in adult cadaveric kidney transplantation: a single-centre retrospective cohort study.

Abstract

Purpose: Desmopressin, a synthetic analogue of vasopressin, is used to prevent uremic bleeding in patients undergoing kidney transplantation but can cause oliguria. Graft function assessment is crucial after kidney transplantation. Urine output (UOP) is the simplest, most feasible, and most cost-effective perioperative monitoring tool to assess graft function in kidney transplantation. No study, to our knowledge, has yet assessed this association in the setting of cadaveric adult kidney transplantation.

Methods: We conducted a retrospective single-centre cohort study to evaluate the impact of desmopressin on UOP in the immediate postoperative period after kidney transplantation at a tertiary care academic hospital in Baltimore, MD, USA. We included a total of 938 adults who received a cadaveric kidney transplant from January 2016 to December 2022 in the study after reviewing selection criteria. As the primary outcome, we compared immediate postoperative UOP (mL·kg^-1) between recipients of desmopressin and nonrecipients of desmopressin. The secondary outcomes of the study were UOP at 12 and 24 hr postoperatively, estimated blood loss (EBL), and postoperative hemoglobin.

Results: Three hundred and fifty-nine (38%) patients received desmopressin intraoperatively. Using multivariable linear regression, desmopressin use was associated with 0.6 mL·kg^-1 lower UOP, representing an average 19% reduction in UOP from a mean UOP of 3.1 mL·kg^-1 in the operating room after adjusting for confounders. A similar reduction in 12- and 24-hr postoperative UOP was also noted (3 mL·kg^-1 and 6 mL·kg^-1, respectively), while desmopressin was associated with a slightly higher EBL. We also observed a dilutional reduction in postoperative hemoglobin.

Conclusions: Intraoperative desmopressin in adult cadaveric kidney transplant recipients was associated with reduced urine output in the postoperative period without any significant hemostatic benefit.