移植手術中的血流動力學與移植腎功能延遲恢復之相關性

林柏廷、林國仁、潘柏諺、朱聖賢、江仰仁、林志德、林美秀、王敘涵

林口長庚紀念醫院 外科部 泌尿科

Intraoperative Hemodynamic Parameters associated with Delayed Graft Function in Kidney Transplant Patients

Po-Ting Lin, Kuo-Jen Lin, Pai-Yen Pan, Sheng-Hsien Chu, Yang-Jen Chiang, Chih-Te Lin, Mei-Hsiu Lin, Hsu-Han Wang

Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose: Intraoperative hemodynamic instability was proven to be associated with delayed graft function (DGF) after kidney transplantation. This retrospective study aims to find the specific intraoperative hemodynamic parameters as an efficient predicting factor of DGF.

Materials and Methods: Patients undergone kidney transplantation between 2020 and 2022 with an intraoperative hemodynamic monitoring system (FloTrac^TM) use were enrolled. The cohort was further classified into DGF and non-DGF groups based on the definition of DGF. The length of operation was divided into three periods: induction to wound incision, wound incision to graft reperfusion, and graft reperfusion to operation complete. Hemodynamic parameters such as central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO), and cardiac index (CI) in different periods were recorded, respectively. A comparison of parameters between these two groups was analyzed.

Results: We enrolled 49 recipients and classified them into the DGF group (n=29) and the non-DGF group (n=20). Compared to the DGF group, incision-to-reperfusion CI was significantly higher in the non-DGF group (4.05 vs. 6.20 L/min/m², p = 0.049). Other parameters revealed no statistical difference. Using incision-to-reperfusion CI as a predicting factor, the prediction of DGF achieved an area under the ROC curve (AUC) of 0.74 (95% CI: 0.6–0.89), with the optimal cut-point value at CI = 4.19 L/min/m².

Conclusions: Incision-to-reperfusion CI was statistically associated with the incidence of DGF and might be used as a valid predicting factor.