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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Related Experiment Video

Updated: Mar 13, 2026

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
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Intraoperative Pleth Variability Index Is Linked to Delayed Graft Function After Kidney Transplantation.

O Collange1, L Jazaerli2, A Lejay3

  • 1Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.

Transplantation Proceedings
|October 30, 2016
PubMed
Summary
This summary is machine-generated.

Higher intraoperative Pleth Variability Index (PVI) predicts delayed graft function (DGF) after kidney transplantation. A PVI greater than 9% before renal artery unclamping was the sole predictor of DGF in this study.

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Area of Science:

  • Nephrology
  • Transplant Surgery
  • Anesthesiology

Background:

  • Delayed graft function (DGF) is a common complication after kidney transplantation (KT), increasing rejection risk and reducing graft survival.
  • Intraoperative hypotension and hypovolemia are linked to DGF, but central venous pressure (CVP) monitoring's reliability is debated.
  • Pleth variability index (PVI) is a dynamic measure of fluid responsiveness.

Purpose of the Study:

  • To investigate the association between intraoperative PVI and CVP values and the incidence of DGF.
  • To determine if PVI can predict DGF in kidney transplant recipients.

Main Methods:

  • Prospective, observational, single-center study including consecutive deceased-donor kidney transplant recipients.
  • Standard, CVP, and PVI monitoring were employed during transplantation.
  • Hemodynamic parameters, including PVI and CVP, were recorded at five intraoperative time points.

Main Results:

  • Forty patients were included; PVI and CVP showed poor correlation (r² = 0.003, P = .44).
  • Patients who developed DGF had significantly higher PVI values compared to those with immediate graft function.
  • A PVI >9% before renal artery unclamping was the only independent predictor of DGF in multivariate analysis (P = .02).

Conclusions:

  • Intraoperative PVI monitoring may help identify kidney transplant recipients at higher risk for DGF.
  • A PVI threshold of 9% during KT is associated with an increased likelihood of developing DGF.