Acute Versus Prolonged Use of Furosemide on Delayed Graft Function in Kidney Transplant Patients

Area of Science:

• Nephrology
• Transplantation Surgery
• Clinical Pharmacology

Background:

• Delayed graft function (DGF) in kidney transplant recipients, defined as requiring dialysis within 7 days post-transplant, is associated with adverse outcomes like acute rejection and reduced allograft survival.
• Furosemide is utilized to mitigate DGF by lowering metabolic demand and ischemic injury, yet optimal postoperative duration remains undefined.

Purpose of the Study:

• To evaluate the impact of postoperative intravenous furosemide duration on the incidence of DGF in kidney transplant recipients.
• To determine if a specific duration of furosemide administration influences early graft function post-transplantation.

Main Methods:

• A single-center, retrospective chart review was conducted on adult kidney transplant recipients between January 1, 2021, and June 30, 2023.
• Patients were stratified into two groups based on furosemide administration duration: less than 48 hours (<48h) or greater than 48 hours (>48h) postoperatively.
• The primary endpoint was DGF, identified by the need for post-transplant dialysis within 7 days of the procedure.

Main Results:

• The study included 200 patients: 64 in the <48h furosemide group and 136 in the >48h group.
• DGF occurred in 6.3% of patients receiving furosemide for <48h versus 39.0% in the >48h group (P < .001).
• Prolonged furosemide use (>48h) was significantly associated with a higher incidence of DGF.

Conclusions:

• Postoperative intravenous furosemide administration exceeding 48 hours in kidney transplant patients is associated with an increased risk of delayed graft function.
• Limiting furosemide duration to less than 48 hours may be a strategy to reduce early DGF after kidney transplantation.
• Further research is warranted to establish evidence-based guidelines for furosemide use in kidney transplant recipients to optimize graft outcomes.