Predictive Value of Intraoperative Doppler Flowmetry for Delayed Graft Function in Kidney Transplantation: A Pilot Study.
Adult
Delayed Graft Function
/ diagnostic imaging
Female
Graft Survival
Hemodynamics
Humans
Kidney
/ blood supply
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Monitoring, Intraoperative
/ methods
Pilot Projects
Predictive Value of Tests
Renal Artery
/ physiopathology
Reperfusion Injury
/ diagnostic imaging
Retrospective Studies
Rheology
/ methods
Risk Assessment
Risk Factors
Transplants
/ blood supply
Ultrasonography, Doppler
/ methods
Journal
Transplantation proceedings
ISSN: 1873-2623
Titre abrégé: Transplant Proc
Pays: United States
ID NLM: 0243532
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
15
01
2020
accepted:
05
02
2020
pubmed:
2
4
2020
medline:
13
11
2020
entrez:
2
4
2020
Statut:
ppublish
Résumé
The delayed graft function (DGF) in kidney transplantation (KT) is a risk factor for long-term poor graft survival. The pathogenesis is multifactorial but mainly related to an ischemia-reperfusion injury. However, the graft hemodynamics have been recently identified as a key aspect for early DGF risk assessment and potential therapeutic intervention. A pilot study on 20 single kidney grafts from donor after brain death with intraoperative measurement of graft arterial flowmetry, 30 minutes after reperfusion. Exclusion criteria were grafts with multiple arteries or severe atherosclerosis of the recipient's external iliac artery. KT recipients with DGF (n = 4, 20%) were homogenous with controls (n = 16) in terms of cold ischemia time, donor age, recipients' hemodynamic parameters, renal artery, and recipients' external iliac artery diameters. Nonetheless, at transplant, the kidney grafts that developed DGF were characterized by a significantly higher renal artery resistive index (DGF vs no-DGF 0.96 ± 0.04 vs 0.77 ± 0.13, P = .02), as well as lower flow extraction rate (24.8% ± 11.8 vs 59.2% ± 21.1, P < .01). Intraoperative arterial graft flowmetry seems to be an effective tool to identify grafts at high risk of DGF.
Sections du résumé
BACKGROUND
BACKGROUND
The delayed graft function (DGF) in kidney transplantation (KT) is a risk factor for long-term poor graft survival. The pathogenesis is multifactorial but mainly related to an ischemia-reperfusion injury. However, the graft hemodynamics have been recently identified as a key aspect for early DGF risk assessment and potential therapeutic intervention.
METHODS
METHODS
A pilot study on 20 single kidney grafts from donor after brain death with intraoperative measurement of graft arterial flowmetry, 30 minutes after reperfusion. Exclusion criteria were grafts with multiple arteries or severe atherosclerosis of the recipient's external iliac artery.
RESULTS
RESULTS
KT recipients with DGF (n = 4, 20%) were homogenous with controls (n = 16) in terms of cold ischemia time, donor age, recipients' hemodynamic parameters, renal artery, and recipients' external iliac artery diameters. Nonetheless, at transplant, the kidney grafts that developed DGF were characterized by a significantly higher renal artery resistive index (DGF vs no-DGF 0.96 ± 0.04 vs 0.77 ± 0.13, P = .02), as well as lower flow extraction rate (24.8% ± 11.8 vs 59.2% ± 21.1, P < .01).
CONCLUSIONS
CONCLUSIONS
Intraoperative arterial graft flowmetry seems to be an effective tool to identify grafts at high risk of DGF.
Identifiants
pubmed: 32229046
pii: S0041-1345(20)30127-5
doi: 10.1016/j.transproceed.2020.02.049
pii:
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1556-1558Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.