Intraoperative Mean Arterial Pressure in Relation to Delayed Graft Function in Living-Donor Kidney Transplantation

Maintaining optimal kidney graft perfusion is a primary goal of intraoperative kidney transplant care, which is often monitored by mean arterial blood pressure (MAP). Delayed graft function (DGF) is a significant complication that is associated with long-term outcomes. The goal of this study is to study the association of various MAP thresholds and the risk of DGF in adult patients undergoing living-donor kidney transplant.

We collected data from the UCLA data warehouse between 2013 and 2024. We analyzed MAP at various thresholds and associated cumulative minutes during the pre- and postreperfusion periods. DGF, defined by dialysis within 7 days of KT, was the primary outcome.

This study comprised 1314 patients. The DGF rate was 5.0%. Forty-two percent experienced at least 1 minute of MAP threshold at ≤60 mm Hg. Those with DGF had longer minutes spent on the MAP thresholds of ≤60 to 85. Adjusted durations of postreperfusion MAP ≤60, 65, 70, 75, 80, and 85 mm Hg associated with the DGF started from 3, 15, 20, 10, 25, and 25 minutes, in that order.

We found an association between intraoperative MAP ≤85 mm Hg and DGF. The minimal duration for postreperfusion ≤60 and ≤85 mm Hg associated with DGF was 3 and 25 minutes, respectively.