Perioperative hemoglobin decrement as an independent risk of poor early graft function in kidney transplantation
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RESEARCH NOTE
Perioperative hemoglobin decrement as an independent risk of poor early graft function in kidney transplantation Arpa Chutipongtanate1, Arpakorn Kantain1, Atiporn Inksathit2, Surasak Kantachuvesiri3,4,5, Vasant Sumethkul3, Siriwan Jirasiritham1, Sopon Jirasiritham4,5 and Somchai Chutipongtanate2,6*
Abstract Objective: Perioperative change of hemoglobin concentration (Hb) was associated with acute kidney injury in patients who underwent non-cardiac surgery, but has never been investigated in kidney transplant patients. This study aimed to observe the effects of perioperative Hb change on early graft function in kidney transplant recipients. Results: A total of 269 kidney transplant patients were enrolled, of whom 98 (36.4%) developed poor early graft function (PEGF), and 171 (63.6%) had immediate graft function. Comparing two groups, patients with PEGF had a greater decremental change of Hb (−1.60 [−2.38,−0.83] vs. −0.70 [−1.35,0.20] g/dL, respectively; p 500 mL
1.71 (0.65–4.49)
0.276
1.73 (0.54–5.59)
0.360
2.86 (0.41–19.95)
0.289
Perioperative Hb decrement >1.35 g/dL
2.52 (1.11–5.72)
0.026
2.89 (1.11–7.55)
0.029
1.68 (0.23–12.15)
0.606
nd no data and not applicable
on the occurrence of PEGF in DDKT patients was demonstrated in Additional file 7: Figure S4. Discussion
This study demonstrated that decremental change in perioperative Hb greater than 1.35 g/dL served as an independent risk of PEGF development in deceased donor kidney transplantation, but not living donors. Deceased donor kidney grafts, which had prolonged ischemic injury, were apparently more vulnerable to changes of hemoglobin levels than kidneys from living donors. Reduction of hemoglobin at a significant level may reduce oxygen delivery to glomeruli and renal tubules, subsequently aggravate graft function impairment in deceased donor kidney transplant. Changes in Hb may represent perioperative insult, particularly intraoperative bleeding in conjunction with hemodilution due to excessive intravenous fluid administration. Our findings support the hypothesis of Guedes-Marques, et al. [18], that perioperative changes in hemoglobin concentration may serve as a novel modifiable factor of PEGF in patients undergoing deceased donor kidney transplant. Several known risk factors of DGF were re-evaluated to clarify their association with PEGF in our study. As expected, CIT was confirmed as the strongest risk of PEGF. Deceased donor type was usually collinear with CIT. It was not surprising that deceased donor type failed to show association with PEGF in multivariate analysis, where CIT had the strongest influence. The previously identified risks of DGF (i.e., older donor, female donor, and higher PRA) [2–4, 15], and PEGF (i.e., recipient BMI, pre-transplant dialysis, and prolonged WIT) [13, 14] were not statistically confirmed as PEGF-associated factors when multivariate analysis was applied, probably due to the relative small
sample size, or their associations were negated under the strong i
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