#621 The effect of intra-operative mean arterial pressure on early graft function in deceased donor kidney transplantation

Abstract

Abstract Background and Aims The adequate perfusion pressure to the graft is essential for proper graft function in kidney transplantation, especially in deceased donor kidney transplantation. In particular, Mean arterial pressure (MAP) during operation can affect early graft function because MAP is associated with renal blood flow and glomerular filtration rate. Therefore, the analysis of intra-operative parameters are necessary to evaluate adequate graft perfusion. The aim of this study is to investigate the relationship between intra-operative parameters including MAP and early graft function in deceased donor kidney transplantation. Method We retrospectively analyzed 363 recipients who underwent deceased donor kidney transplantation from March 2010 to December 2020. Anesthetic monitoring data during intraoperative period was analyzed and basic clinical parameters were evaluated. Results In total 363 recipients, the mean recipient age was 48.9 ± 10.3 and mean donor age was 48.2 ± 15.2. Anesthetic time was mean 285.9 ± 63.8 (min) and operation time was 226.4 ± 48.7 (min). Median value of baseline MAP and MAP at reperfusion were 124 mmHg and 88 mmHg. After initial analysis, the recipients were divided into two groups, high MAP group (n = 185) and low MAP group (n = 178), according to median value of baseline MAP (124 mmHg) and these two groups were analyzed. High MAP group showed higher estimated glomerular filtration rate (eGFR) and urine output compared to low MAP group during immediate postoperative 1 week. At postoperative day 5, eGFRs were 43.4 ± 26.7 and 37.3 ± 24.2 mL/min/1.73 m2 respectively (p = 0.022) and urine outputs were 2942.6 ± 1368.6 and 2474.3 ± 1199.1 mL respectively (p = 0.001). The incidences of delayed graft function showed no significant difference between two groups (2.2% vs 6.2%, p = 0.066). We additionally analyzed the effect of MAP at reperfusion, and the result showed that there was no significant relationship between MAP at reperfusion and early graft function. Conclusion In this retrospective study, MAP at reperfusion was not significantly related to early graft function and incidence of delayed graft function. In baseline MAP analysis, high baseline MAP group showed early recovery of eGFR and more urine output than low baseline MAP group. As a result, the recipients with high baseline MAP were related to early recovery of graft function in deceased donor kidney transplantation.