JMIR Publications

ABSTRACT

Background:

Intraoperative hemodynamic support during deceased donor renal transplants (DDRTs) frequently involves vasopressors and crystalloid administration; however, theoretical concerns persist that vasopressors may contribute to adverse outcomes by reducing renal perfusion through vasoconstriction, while excessive fluid administration may contribute to renal congestion and impaired microcirculatory flow. Few studies investigate the impact of intraoperative vasopressor exposure on graft outcomes.

Objective:

In this pilot study, we assessed the relationship between intraoperative vasopressor use and early graft function in a single-center cohort of DDRTs.

Methods:

We conducted a retrospective analysis of adults (≥18 years) DDRT recipients at a single institution between 2020 and 2022. Demographic variables, donor and graft characteristics, intraoperative vasopressor exposure, and postoperative outcomes were extracted from the electronic medical record under institutional review board approval. Primary endpoints included DGF, estimated glomerular filtration rate (eGFR) at 90 days, and graft failure at 1 year. Multivariable regression models were constructed adjusting for donor age, recipient age, and sex, as well as vasopressor exposure variables.

Results:

Ninety DDRT procedures were included (mean recipient age 52.1 years; mean donor age 42.1 years; 57 male recipients). Intraoperative vasopressors were administered in 82 cases. Phenylephrine was most used (n=75), including both infusion (n=68, mean total dose 4,906 mcg, rate range 10-100mcg/min) and bolus administration (n=57; mean 345 mcg). Additional agents included ephedrine (n=15), norepinephrine infusion (n=4), and vasopressin (n=3). Vasopressors were administered after graft reperfusion in 70 patients. Mean intraoperative crystalloid administration was 2.5L per patient. DGF occurred in 26 patients. Mean 90-day eGFR was 62.2 mL/min/1.73m². Graft failure occurred in 6 patients at 12 months. After adjustment, vasopressor exposure was not significantly associated with 90-day eGFR or DGF across multiple exposure definitions.

Conclusions:

Intraoperative vasopressor use was not associated with adverse short-term graft outcomes, including delayed graft function and 90-day EGFR. These findings support that clinically indicated vasopressor use during DDRT does not adversely affect renal function postoperatively. Though limited by small sample size, this supports the use of intraoperative vasopressors during DDRT.