Effects of Perioperative Management on Short-Term Renal Transplant Outcome: A Retrospective Cohort Study

There are limited data on how intraoperative hemodynamic factors influence pediatric kidney transplant outcomes, particularly across the different phases of graft reperfusion. With the widespread introduction of anesthesia information management systems, new opportunities have emerged to explore how intraoperative management affects transplant outcomes.

We conducted a retrospective cohort study at a single center, including transplant recipients under 19 years of age who underwent kidney transplantation between 2010 and 2022 (n = 121). Data were extracted from chart reviews, anesthesia records, and an intraoperative monitoring databank. Modeling for clinical variables alone, intraoperative variables alone, and combined clinical-intraoperative features was analyzed with respect to three outcomes: Unadjusted glomerular filtration rate at one-month post-transplant (uGFR_1M), time to creatinine nadir, and length of hospital stay.

Longer duration of pre-unclamp mean arterial pressure (MAP) below the 95th percentile (β = -0.086, p = 0.009), a greater number of inotropes used during the pre-unclamp period (β = -4.00, p = 0.017), and higher MAP variability in the first 30 min post-unclamp (β = -1.38, p = 0.006) were each independently associated with lower uGFR_1M. A greater volume of fluid administered in the pre-unclamp period was independently associated with a longer time to creatinine nadir (β = 0.002, p = 0.01).

Intraoperative features related to pre-unclamp volume resuscitation, MAP control, and post-unclamp hemodynamic instability are associated with slower graft function in pediatric kidney transplantation.