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Published on: July 15, 2015
Effect of perioperative management on early graft function in living donor paediatric kidney transplantation
Jennifer Q J Zhang1,2, Elena Cavazzoni3,4, Anne M Durkan2,4
1Sydney Medical Program, The University of Sydney, Camperdown, Sydney, Australia.
Insights
Targeted perioperative management in paediatric kidney transplants did not significantly impact early graft function. This study found no correlation between fluid and hemodynamic parameters and estimated glomerular filtration rate (eGFR) post-transplant.
Area of Science:
- Nephrology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Paediatric kidney transplantation carries high risks for surgical and vascular complications.
- Postoperative intensive care monitoring is crucial for these young patients.
Purpose of the Study:
- To investigate the impact of perioperative management on early graft function in paediatric living donor kidney transplantation.
- To determine if specific fluid and hemodynamic parameters influence graft outcomes.
Main Methods:
- Retrospective analysis of clinical data from living donor paediatric kidney transplants (2009-2021) in New South Wales, Australia.
- Calculation of estimated glomerular filtration rate (eGFR) at 7 days and 1 month post-transplant as primary outcome measures.
- Analysis of intraoperative and postoperative fluid administration, vasoactive agent use, central venous pressure (CVP), and systolic blood pressure (BP).
Main Results:
- Thirty-nine paediatric patients were analyzed, with a median age of 6 years.
- Achieved targeted intraoperative and postoperative fluid volumes and hemodynamic parameters.
- No significant association found between CVP, systolic BP, and 1-month eGFR after adjusting for age.
Conclusions:
- Achieved targeted perioperative fluid and hemodynamic parameters in paediatric kidney transplantation.
- These specific perioperative management strategies did not correlate with early graft function (eGFR).
- Further research may be needed to identify optimal management strategies for improving early graft outcomes.
Background:
Paediatric kidney transplantation has an increased risk of surgical and vascular complications, with intensive care monitoring required postoperatively. This study aimed to determine if perioperative management affects early graft function in living donor paediatric kidney transplantation.
Methods:
Clinical data was extracted from the electronic medical record for living donor kidney transplants at two paediatric centres covering the state of New South Wales (NSW), Australia from 2009 to 2021. Estimated glomerular filtration rate (eGFR) of 7 days and 1-month post-transplant were calculated as measures of early graft function.
Results:
Thirty-nine eligible patients (female n (%) 13 (33%)) with a median (IQR) age of 6 (3-9) years and pre-transplant eGFR of 7 (6-10) mL/min/1.73 m2 were analysed. Mean (SD) central venous pressure (CVP) after revascularisation was 11 (4) mmHg. Intraoperatively, mean volume of fluid administered was 84 (39) mL/kg, and 34 (87%) patients received vasoactive agents. Average systolic blood pressure (BP) in the first 24-h post-transplant was 117 (12) mmHg. Postoperatively, median volume of fluid administered in the first 24 h was 224 (159-313) mL/kg, and 17 (44%) patients received vasoactive agents. Median eGFR 7 days and 1-month post-transplant were 115 (79-148) and 103 (83-115) mL/min/1.73 m2, respectively. Linear regression analyses demonstrated that after adjusting for age, the average CVP after revascularisation and average systolic BP in the first 24-h post-transplant were not associated with eGFR in the first month post-transplant.
Conclusions:
Targeted intraoperative and postoperative fluid and haemodynamic characteristics were achieved but did not correlate with early graft function.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
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