肾移植术中平均动脉压与术后延迟移植物功能：评估三种常用阈值

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-09-20 DOI:10.1111/ctr.15458

Chinnarat Pongpruksa, Nutchanok Khampitak, Drew Chang, Suphamai Bunnapradist, Hans Gritsch, Victor W. Xia

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引用次数: 0

摘要

背景移植功能延迟（DGF）是肾移植（KT）后常见的早期并发症，与各种长期不良预后有关。尽管对血液动力学管理进行了大量研究，但 KT 期间的最佳血液动力学目标仍不明确。在这项回顾性研究中，我们旨在调查临床实践中常用的三种平均动脉压（MAP）阈值（≤75、80 和 85 mmHg）是否与接受 KT 的成年患者的 DGF 相关。方法我们从发现数据存储库中提取了接受过死亡供体 KT 的成年患者的去标识化数据。DGF定义为移植后头7天内需要透析。记录了三个血压阈值（≤75、80 和 85 mmHg）以及血压低于三个阈值的持续时间。采用多变量逻辑分析确定 DGF 的风险因素。结果我们纳入了 2301 名成年 KT 患者。平均年龄为（52.5±12.9）岁，59%为男性。1066例患者（46.3%）发生了DGF。患者经常出现 MAP ≤75、80 和 85 mmHg 的情况（分别约有 70%、80% 和 90% 的患者在 10 分钟内出现 MAP ≤75、80 和 85 mmHg 的情况）。与无 DGF 的患者相比，有 DGF 的患者在手术中低于三个 MAP 临界值的时间明显更长。进一步分析表明，MAP≤75、80 和 85 mmHg 与 DGF 显著相关的最短时间分别为 6、23 和 37 分钟。在调整了非血流动力学风险因素（年龄、使用巴利昔单抗和尿量）后，长时间处于三个 MAP 临界值仍是 DGF 的重要预测因素（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）。结论在成人死亡供体 KT 过程中经常出现长时间暴露于三个常见的 MAP 临界值（≤75、80 和 85 mmHg）的情况，这与 DGF 有关。

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

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.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.