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Updated: Jul 15, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Intraoperative Mean Arterial Pressure and Postoperative Delayed Graft Function in Kidney Transplantation: Evaluating
Chinnarat Pongpruksa1,2, Nutchanok Khampitak3, Drew Chang1
1Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA, Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Insights
Maintaining adequate mean artery pressure (MAP) during kidney transplantation (KT) is crucial. Prolonged periods below common MAP thresholds (≤75, 80, 85 mmHg) are linked to delayed graft function (DGF) in adult KT recipients.
Area of Science:
- Nephrology
- Transplantation Surgery
- Critical Care Medicine
Background:
- Delayed graft function (DGF) is a frequent complication following kidney transplantation (KT), impacting long-term outcomes.
- Optimal hemodynamic management during KT remains incompletely defined.
- This study investigates the association between specific mean artery pressure (MAP) thresholds and DGF.
Purpose of the Study:
- To evaluate the relationship between three common MAP thresholds (≤75, 80, and 85 mmHg) and the incidence of DGF in adult KT patients.
- To identify critical durations of hypotension associated with DGF.
Main Methods:
- Retrospective analysis of de-identified data from adult deceased donor KT recipients.
- DGF defined as the need for dialysis within 7 days post-transplant.
- Multivariable logistic regression used to analyze MAP thresholds and durations as risk factors for DGF.
Main Results:
- 2301 adult KT patients were included; 46.3% experienced DGF.
- A high prevalence of hypotension was observed across all MAP thresholds.
- Prolonged durations below MAP thresholds of ≤75 mmHg (≥6 min), ≤80 mmHg (≥23 min), and ≤85 mmHg (≥37 min) were significantly associated with DGF, even after adjusting for other risk factors.
Conclusions:
- Frequent and prolonged exposure to common MAP thresholds (≤75, 80, 85 mmHg) during adult deceased donor KT is associated with an increased risk of DGF.
- These findings highlight the importance of maintaining adequate intraoperative MAP to improve early graft outcomes in KT.
Background:
Delayed graft function (DGF) is a common early complication after kidney transplantation (KT) and is associated with various long-term adverse outcomes. Despite numerous studies on hemodynamic management, the optimal hemodynamic goals during KT remain unclear. In this retrospective study, we aimed to investigate if three mean artery pressure (MAP) thresholds (≤75, 80, and 85 mmHg) that were commonly used in clinical practice were associated with DGF in adult patients undergoing KT.
Methods:
We extracted de-identified data on adult patients who underwent deceased donor KT from our Discovery Data Repository. DGF was defined as the requirement for dialysis within the first 7 days after transplantation. Three MAP thresholds (≤75, 80, and 85 mmHg) and the duration of pressure below the three thresholds were recorded. Multivariable logistic analysis was used to identify risk factors for DGF.
Results:
We included 2301 adult KT patients. The mean age was 52.5±12.9 years and 59% were male. DGF occurred in 1066 patients (46.3%). Patients frequently experienced MAP ≤75, 80, and 85 mmHg (approximately 70%, 80%, and 90% of patients experienced 10 min of MAP ≤75, 80, and 85 mmHg, respectively). Patients with DGF spent significantly longer durations below the three MAP thresholds during surgery compared with those without DGF. Further analysis revealed that the minimal time spent on MAP ≤75, 80, and 85 mmHg that were significantly associated with DGF were 6, 23, and 37 min, respectively. After adjusting for non-hemodynamic risk factors (age, basiliximab administration, and urine output), prolonged exposure to the three MAP thresholds remained significant predictors for DGF (for MAP ≤75 mmHg, OR 1.257, 95% CI 1.017-1.554, p = 0.034; MAP ≤80 mmHg, OR 1.220, 95% CI 1.018-1.463, p = 0.031; MAP ≤85 mmHg, OR 1.253, 95% CI 1.048-1.498, p = 0.013).
Conclusion:
Prolonged exposure to the three common MAP thresholds (≤75, 80, and 85 mmHg) occurred frequently during adult deceased donor KT and was associated with DGF.
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