Abstract：
Delayed graft function (DGF) increases morbidity and mortality in kidney transplant recipients. Operative parameters, including hemodynamic manipulation through vasopressors and fluids, can impact perfusion to the newly transplanted kidney and influence DGF incidence. We analyzed intraoperative time-series data in 5-minute intervals from kidney transplant recipient operations (N = 545) in conjunction with pretransplant characteristics and postsurgical outcomes, including DGF incidence, 60-day creatinine, and graft survival. Of the operations, 127 DGF events were captured in our cohort from a single academic transplant center (57/278 donations after brainstem death [DBDs], 65/150 donations after circulatory/cardiac death [DCDs], 5/117 live donations). In multiple regression, postanastomosis hypotension defined as mean arterial pressure (MAP) <75 mmHg was a risk factor for DGF independent of conventional predictors of DGF in DCD and DBD kidneys. DCD recipients with DGF had lower average postanastomosis MAP (DGF: 80.1 ± 8.1 mmHg vs no DGF: 76.4 ± 6.7 mmHg, P = .004). Interaction analysis demonstrated above-average doses of vasopressors and crystalloids were associated with improved outcomes when used at MAPs ≤75 mmHg, but they were associated with increased DGF at MAPs >75 mmHg, suggesting that the incidence of DGF can be highly influenced by intraoperative hemodynamic controls. This analysis of surgical time courses has identified potential new strategies for goal-directed anesthesia in renal transplantation.
摘要：
移植肾功能延迟（DGF）增加肾移植受者的发病率和死亡率。操作参数,包括通过血管加压药和液体进行的血液动力学操作可以影响新移植肾的灌注并影响DGF的发生率。我们分析了来自肾移植受者手术（n=545）的5分钟间隔的术中时间序列数据，并结合移植前特征和手术后结果，包括DGF发病率，60天肌酐，和移植物存活。在我们的队列中，从一个学术移植中心捕获了127个DGF事件（57/278DBD，65/150DCD,5/117活体捐赠者）。在多元回归中，吻合后低血压定义为MAP<75mmHg是DGF的危险因素，独立于DGF的常规预测因子，DCD和DBD肾脏。DCD患者DGF吻合后平均MAP较低（DGF：80.1±8.1mmHg与无DGF：76.4±6.7mmHg，p=0.004)。相互作用分析表明，高于平均水平的血管升压药和晶体样剂量在75mmHg或更低的MAP下使用时，与改善的结局相关。但与高于75mmHg的MAP时DGF增加有关，提示术中血流动力学控制可高度影响DGF的发生率。对手术时间过程的分析确定了肾移植中目标导向麻醉的潜在新策略。[193/200字]。
