Factors influencing QTc interval prolongation during kidney transplantation

During renal transplantation, factors causing disturbances of the repolarization process, defined by the QT interval, may lead to ventricular arrhythmias. The aim of this study was to determine a relationship between QT interval prolongation and metabolic homoeostasis, and durations of cold ischemia time (CIT) and warm ischemia time (WIT) during renal transplantation.

From among 198 consecutive renal transplant patients, 68 (mean age 45 ± 12 years) were included in a prospective observational pilot study. Prior to the procedure, arterial blood gas analysis was performed, and digital Holter ECG monitoring was applied and continued for 12 hours. Subsequent arterial blood gas analysis was performed 30 minutes after graft reperfusion.

QTc changed dynamically and significantly during the perioperative period. Ventricular arrhythmias were observed only during graft reperfusion. Recordings showed that 33 out of 68 patients had ventricular extrasystoles, and non-sustained ventricular tachycardia was observed in 2 patients. No patients presented with hemodynamic instability. There was no statistical correlation between CIT or WIT and the difference (delta) between the final and initial values of the pH, potassium and lactate levels, QTc range, maximal QTc or QTc measured at the predefined time points.

The renal transplantation procedure carries a high risk of ventricular repolarization period disturbances that can lead to life-threatening tachyarrhythmias despite optimal hemodynamic or metabolic status and independent of CIT and WIT.