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

Delayed graft function (DGF) is a multifactorial clinical entity. The aim of our study was to analyze the role of perioperative fluid and noninvasive hemodynamic parameters in DGF patients.

The medical records of 122 adult deceased donor kidney transplant patients were retrospectively analyzed with respect to donor (medical history, kidney donor risk index), recipient (medical history), transplant (cold-warm ischemia time, renal arterial resistive index), and perioperative anesthetic, especially noninvasive hemodynamic management. Patients were grouped as DGF and immediate graft function.

Prevalence of DGF was 21.3% (n = 26). Delayed graft function was related to higher donor body mass index (P = .04), kidney donor risk index higher than 1.6 (P = .008), recipient age older than 65 years (P = .03), and perioperative factors, such as lower residual diuresis of recipient (8.7 [SD, 5.2] mL/kg vs 14.4 [SD, 10.3] mL/kg; P = .005), higher intradialytic weight gain (2.65 [SD, 1.03] kg vs 2.16 [SD, 0.79] kg; P = .07), and higher fluid balance during the first postoperative day (3310 [SD, 1230] mL vs 2354 [1812] mL; P = .01). The curve of change in systolic blood pressure (SBP) showed a tick mark pattern in DGF and a semicircular shape in the immediate graft function group. In the DGF group, SBP change compared with baseline value was higher at reperfusion (-3.16% [SD, 23.37%] vs -12.84% [SD, 23.37%]; P = .047), at the ending of surgery (-5.83% [SD, 26.21%] vs -3.26% [SD, 21.81%]; P = .07), and at the ending of anesthesia (11.81% [SD, 29.77%] vs -1.26% [SD, 21.87%]; P = .01). The postoperative renal arterial resistive index was higher in the DGF group (0.75 [SD, 0.10] vs 0.69 [SD, 0.08]; P = .007).

The tick mark pattern of SBP kinetics might help to identify DGF intraoperatively. When detecting this SBP pattern, the excessive fluid therapy should be avoided during the postoperative period to prevent iatrogenic hypervolemia leading to further graft damage.