The Surgical Apgar Score is Associated with Delayed Graft Function after Deceased-Donor Kidney Transplantation: A...

Delayed graft function (DGF) remains a frequent complication after deceased-donor kidney transplantation and is associated with adverse graft outcomes. The surgical Apgar score is a simple 10-point intraoperative composite score based on lowest heart rate, lowest mean arterial pressure and estimated blood loss, but its association with DGF remains unclear.

This monocentric retrospective study included all consecutive adult recipients of a deceased-donor kidney transplant performed between 2016 and 2021. A low surgical Apgar score was defined as ≤7 and DGF as the need for dialysis within 7 days after transplantation. Associations between surgical Apgar score, established determinants of DGF and outcomes were assessed using multivariable logistic regression.

Among 301 recipients, 95 (32%) had a low surgical Apgar score. Low surgical Apgar score was associated with recipient age (OR 0.86 per 5 years, 95% CI 0.78-0.94), body mass index (OR 1.05 per kg/m2, 95% CI 1.01-1.10) and surgery duration (OR 1.03 per 5 minutes, 95% CI 1.00-1.06). Estimated blood loss was the main contributor to low surgical Apgar score. DGF occurred in 79 patients (26%) and was independently associated with low surgical Apgar score (OR 2.05, 95% CI 1.16-3.61), dialysis vintage (OR 1.05 per 6 months, 95% CI 1.01-1.10), absence of renin-angiotensin system inhibitor therapy (OR 2.27, 95% CI 1.27-4.00) and cold ischemia time (OR 1.11 per 2 hours, 95% CI 1.02-1.21).

Low Surgical Apgar Score during kidney transplantation is independently associated with DGF. This score is available right after surgery for anesthesiologists, surgeons, and nephrologists. Intraoperative blood loss and heart rate may represent key modifiable factors influencing early graft function.