Perioperative hemoglobin decrement as an independent risk of poor early graft function in kidney transplantation

Perioperative change of hemoglobin concentration (Hb) was associated with acute kidney injury in patients who underwent non-cardiac surgery, but has never been investigated in kidney transplant patients. This study aimed to observe the effects of perioperative Hb change on early graft function in kidney transplant recipients.

A total of 269 kidney transplant patients were enrolled, of whom 98 (36.4%) developed poor early graft function (PEGF), and 171 (63.6%) had immediate graft function. Comparing two groups, patients with PEGF had a greater decremental change of Hb (-1.60 [-2.38,-0.83] vs. -0.70 [-1.35,0.20] g/dL, respectively; p < 0.001). A Hb cut-point of -1.35 g/dL was obtained from ROC analysis. Multivariate analysis showed that perioperative Hb decrement greater than 1.35 g/dL was an independent risk of PEGF (adjusted OR of 2.52, 95% CI 1.11-5.72; p = 0.026). Subgroup analysis revealed deceased donor kidney transplant (DDKT; n = 126) (adjusted OR of 2.89, 95% CI 1.11-7.55; p = 0.029), but not living donor kidney transplantation (LDKT; n = 143) (adjusted OR of 1.68, 95% CI 0.23-12.15; p = 0.606), was influenced by the perioperative Hb decrement. In conclusion, this study suggests that decremental change in perioperative Hb greater than 1.35 g/dL may serve as a modifiable factor of PEGF in DDKT.