Pediatric Renal Transplants: Effects of Intraoperative Management on Postoperative Kidney Function

Physiological management during pedi-atric renal transplants may affect outcomes secondary to intraoperative organ perfusion. Our goal was to investigate intraoperative factors affecting postope-rative renal function. We investigated whether mean arterial pressure, total intravenous fluids, central venous and invasive arterial pressure monitoring, and epidural analgesia would correlate with postoperative serum creatinine.

The design was a retrospective cohort study. Pediatric renal transplants performed from 2016 to 2022 were included, and 47 patients age <18 years were included. The primary outcome variables were creatinine levels at postoperative day 1 and day 30.

There was a significant negative correlation between weight-adjusted mean arterial pressure after reperfusion and day 30 creatinine (r = -0.55; P < .001). There was also a significant negative correlation between transfused volume of red blood cells and day 30 creatinine (r = -0.73; P = .0068). Epidural catheter placement was associated with significantly lower median serum creatinine on day 1 (111 vs 248 μmol/L; P = .012) and lower mean serum creatinine on day 30 (62.5 ± 29.2 vs 92.5 ± 35.3 μmol/L; P = .011). Patients with epidural catheters received a significantly greater mean volume of intravenous fluids versus the nonepidural group (82.5 ± 23.4 vs 65.2 ± 25.7 mL/kg;P = .042). There was no correlation between total infused intravenous fluids and day 1 or day 30 postoperative serum creatinine. No correlation was found between central venous pressure monitoring, invasive arterial pressure monitoring, and posto-perative creatinine.

Mean arterial pressure after reperfusion, transfused volume of red blood cells, and epidural analgesia had a measurable effect on posttransplant kidney function. Variations in total infused intravenous fluids and the use of invasive hemodynamic moni-toring did not correlate with postoperative serum creatinine.