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Prospective assessment of the impact of intraoperative diuretics in kidney transplant recipient surgery

  • 0From the Departments of Surgery (Levine, Rasmussen, Luke, Sener) and Microbiology & Immunology (Sener), Schulich School of Medicine & Dentistry, Western University, London, Ont.; the Matthew Mailing Centre for Translational Transplant Studies, London, Ont. (Lee, Rim, Farokhi, Luke, Sener); the Multi-Organ Transplant Program, London Health Sciences Centre, University Hospital, London, Ont. (Levine, Rasmussen, Luke, Sener); and the Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alta. (Levine, Rasmussen).
Canadian Journal of Surgery. Journal Canadien De Chirurgie +

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April 4, 2024

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April 4, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Intraoperative diuretics like furosemide or mannitol may reduce delayed graft function (DGF) after kidney transplantation. Pooled analysis showed a significant reduction in DGF when any diuretic was used compared to no diuretic.

Area Of Science

  • Nephrology
  • Transplantation Surgery
  • Pharmacology

Background

  • Delayed graft function (DGF) is a complication following kidney transplantation.
  • Intraoperative diuretics (furosemide, mannitol) are anecdotally used to prevent DGF, but evidence is limited.
  • Practice patterns for diuretic use in kidney transplantation vary significantly.

Purpose Of The Study

  • To evaluate the efficacy of intraoperative furosemide or mannitol in reducing DGF after kidney transplantation.
  • To compare DGF rates between patients receiving diuretics and those not receiving diuretics.
  • To assess secondary outcomes including graft function and potassium levels.

Main Methods

  • A cohort study design was employed.
  • Adult kidney transplant recipients were allocated to receive furosemide, mannitol, or no diuretic intraoperatively before reperfusion.
  • Primary outcome was DGF; secondary outcomes included 30-day graft function and perioperative potassium levels.

Main Results

  • 162 deceased donor kidney transplants were analyzed over two years.
  • No significant difference in DGF rates was observed between individual furosemide, mannitol, and control groups.
  • Pooled analysis of diuretic use (furosemide or mannitol) showed a significant reduction in DGF odds compared to the control group (OR 2.10, p=0.03).

Conclusions

  • Intraoperative administration of furosemide or mannitol may decrease the incidence of DGF in kidney transplant recipients.
  • The findings suggest a potential benefit of using intraoperative diuretics to improve early kidney graft outcomes.
  • A randomized controlled trial is recommended to confirm these findings and establish definitive evidence.

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