Impact of FloTrac versus hypotension prediction index (HPI)-guided haemodynamic management on intraoperative hypotension in kidney transplantation: A retrospective observational study.

Abstract

Background and aims: Intraoperative hypotension (IOH) is inevitable during moderate-to-high-risk surgeries. In kidney transplantation, intraoperative hypotensive events can badly affect postoperative graft and patient outcomes. Traditionally, central venous pressure monitoring has been regarded as a fundamental aspect of intraoperative haemodynamic management during kidney transplantation. Recently, the focus has changed by including newer haemodynamic tools (FloTrac, Hemosphere, etc.) to reduce intraoperative hypotensive events and postoperative complications. The primary objective was to record IOH (incidence, duration, and severity).

Methods: This study was done retrospectively to observe the effect of haemodynamic monitoring on IOH. Recipients with dilated cardiomyopathy (DCMP) aged 18-60 years who underwent kidney transplantation from June 2022 to May 2024 were included and had cardiac output measured by FloTrac or Hemosphere. The primary outcome was to record the time-weighted average (TWA) of IOH. Secondary outcomes were to record the average number of hypotensive events per patient and the average duration of each hypotensive event.

Results: Twenty-eight patients with DCMP were included. The primary outcome of TWA of the area under threshold (MAP < 65 mmHg) per patient was more in patients in the FloTrac group in comparison to the Acumen group (P = 0.613). Secondary outcomes, namely the incidence of hypotensive events per patient and total time of hypotension, were significantly higher in the FloTrac group as compared to the Acumen group (P < 0.0001).

Conclusion: Hypotension prediction index (HPI) provides superior intraoperative haemodynamic management in kidney transplant recipients with DCMP in terms of reduced duration, incidence, and severity of IOH.