Systolic Blood Pressure Pattern: The Tick Mark Signal of Delayed Renal Graft Function

Area of Science:

• Nephrology
• Transplant Surgery
• Anesthesiology

Background:

• Delayed graft function (DGF) is a complex clinical issue following kidney transplantation.
• Understanding perioperative fluid management and hemodynamic parameters is crucial for DGF prevention.

Purpose of the Study:

• To investigate the association between perioperative fluid balance, noninvasive hemodynamic parameters, and the occurrence of DGF.
• To identify predictive factors for DGF in deceased donor kidney transplant recipients.

Main Methods:

• Retrospective analysis of 122 adult deceased donor kidney transplant recipients.
• Evaluation of donor, recipient, transplant, and perioperative anesthetic factors, including noninvasive hemodynamics.
• Comparison of patients with DGF versus those with immediate graft function.

Main Results:

• DGF prevalence was 21.3% and associated with higher donor BMI, elevated kidney donor risk index, and older recipient age.
• Perioperative factors linked to DGF included lower residual diuresis, higher intradialytic weight gain, and greater postoperative fluid balance.
• A distinct 'tick mark' pattern in systolic blood pressure (SBP) changes was observed in the DGF group during surgery and anesthesia.

Conclusions:

• The 'tick mark' SBP pattern may serve as an intraoperative indicator for DGF risk.
• Avoiding excessive postoperative fluid administration is recommended when this SBP pattern is detected to prevent iatrogenic hypervolemia and subsequent graft injury.