MP31-05 TOWARDS GOAL-DIRECTED ANESTHESIA DECISION-MAKING IN KIDNEY TRANSPLANTATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP31-05 TOWARDS GOAL-DIRECTED ANESTHESIA DECISION-MAKING IN KIDNEY TRANSPLANTATION Rohit Malyala, Anna-Lisa Nguyen, Erika Escamilla, Lucie Hammond, Sasha Vozynuk, Hana Mehdic, and Christopher Nguan Rohit MalyalaRohit Malyala More articles by this author , Anna-Lisa NguyenAnna-Lisa Nguyen More articles by this author , Erika EscamillaErika Escamilla More articles by this author , Lucie HammondLucie Hammond More articles by this author , Sasha VozynukSasha Vozynuk More articles by this author , Hana MehdicHana Mehdic More articles by this author , and Christopher NguanChristopher Nguan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative hemodynamics are understood to influence the incidence of delayed graft function (DGF), defined as the need for dialysis within one week of transplant. However, there is limited evidence on best practices in anesthesia, pressor use, and fluid management in transplant recipients. We aim to characterize features of intra-operative anesthesia courses in order to determine whether such parameters associate with DGF. METHODS: 671 kidney transplant recipients were included from surgeries performed at a single academic medical centre (Vancouver General Hospital, 2014-2020) based on availability of the anesthetic record, operative note, and discharge summary. The anesthetic records comprised medications and fluids administered (including quantities, timing, and rate of administration), and hemodynamics throughout the procedure, in 5 minute intervals. Information on major time points such as timing of vascular clamp, anastomosis, etc. were obtained from post-operative notes. Repeated univariate logistic regression after feature extraction of time-series variables was used for hypothesis testing. RESULTS: 142 DGF events were captured in our cohort (62/294 NDD; 80/167 DCD; 11/210 LD). Notably, diastolic blood pressure and mean arterial pressure throughout the operation were substantially lower in DGF recipients (average DBP: p=0.001, average MAP: p=0.002). Limiting analysis to DCD/NDD grafts, intraoperative hypotension expressed as the lowest intraoperative MAP post-anastomosis was significantly associated with DGF incidence, with greater hypotension susceptibility noted in DCD over NDD grafts. An interaction logistic terms regression analysis between lowest post-anastomosis MAP and pressor use was also performed, which indicated that DGF incidence in both DCDs and NDDs was lower in low-MAP patients (<65mmHg) when pressors were used, but that DGF incidence was higher in patients where pressors were used if the lowest intra-operative MAP was above 65 mmHg. CONCLUSIONS: We have collated a highly granular transplant anesthesia dataset depicting a preliminary view into intraoperative hemodynamics and decision-making. Future steps include further interrogation of the data and prospective study to inform goal-directed anesthesia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e431 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Malyala More articles by this author Anna-Lisa Nguyen More articles by this author Erika Escamilla More articles by this author Lucie Hammond More articles by this author Sasha Vozynuk More articles by this author Hana Mehdic More articles by this author Christopher Nguan More articles by this author Expand All Advertisement PDF downloadLoading ...