Klinisch I - P15 - Circulatory support and the immediate graft function in pediatric kidney transplantation

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M Pheninckx, A.M. Terpstra, C.E.J. Sloots, A. Gonzalez Candel, H. de Jong, E.A.M. Cornelissen, A.H. Bouts, M. Voet-Lindner, K. Cransberg

Chair(s): prof. dr. Jaap Homan van der Heide, nefroloog, AMC

Thursday 10 march 2016

13:30 - 14:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

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Introduction:
During transplantation of an adult donor kidney in a pediatric recipient a supra-pediatric blood pressure is targeted for at the time of revascularization (RV) to facilitate an optimal perfusion of the graft. Aim of this study was to investigate the effect of fluid and inotropic management on 1) the blood pressure at RV and 2) the speed of graft recovery after RV.

Methods:
In this prospective, multicentre, ongoing study, data of 30 consecutive children who underwent a kidney transplantation (KT) at one centre are presented. A blood pressure of 100-115/60-75 mmHg at revascularization, dependent on recipient age, was aimed at, using crystalline and colloidal fluid therapy (in mL/kg), with or without inotropic support by dopamine and/or noradrenaline. The primary outcome measure was the half-life of the serum creatinine immediately before revascularization (T1/2[SCr_RV]). Secondary outcome measures were the blood pressure at revascularization and the estimated glomerular filtration rate at 3 months after KT (eGFR_M3).

Results:
The median T1/2[SCr_RV] was 11.6 hours (IQR, 6.4-15.8). In univariate Cox regression analyses a shorter T1/2[SCr_RV] was associated with pre-emptive KT (P=0.03) and grafts of living donors (P=0.04), but not with recipient age, the relative amount of fluid administered and vasopressor score (dopamine dose [μg/kg/min] × 1) + (noradrenaline [μg/kg/min] × 100) at RV. In the multivariate model a shorter T1/2[SCr_RV] was associated with a lower vasopressor score at RV (hazard ratio, 0.94; 95% CI, 0.90-0.97; P<0.001), adjusted for recipient age, living donor graft, pre-emptive KT and the amount of administered fluid.

The median eGFR_M3  was 59.5 (IQR, 45.0-80.3) mL/min/1.73m². Using univariate linear regression analyses, a higher eGFR_M3 wasassociated with younger recipient age (P=0.001), a larger amount of administered fluid during surgery (P<0.001) and a higher vasopressor score at RV (P=0.02). In a multivariate model these relations were not significant anymore.

The blood pressure increased; in children < 10 years from median 79/37 mmHg 2 hr before RV to 106/54 mmHg at the time of RV, in those ≥ 10 years from 97/50mmHg to 124/58 mmHg.

Conclusion:
Circulatory support during surgery resulted in an increase of the blood pressure. Contrary to our expectations, inotropic support impaired immediate graft recovery, whereas fluid administration did not affect it significantly. The eGFR_M3 was not affected by inotropic support or fluid management.