Intraoperative hypotension and prolonged operative time as risk factors for slow graft function in kidney transplant recipients.

Background: Slow graft function (SGF) is an immediate post-operative complication of cadaveric kidney transplantation pre-disposing to acute rejection (AR) and lower graft survival. The objective of this study was to test whether intraoperative hypotension and/or prolonged operative time are risk factors for SGF in patients post-cadaveric kidney transplant.

Methods: This was a single center retrospective case-control study of patients post-cadaveric kidney transplant performed at the University of Kansas Medical Center (KUMC) between January 2002 and February 2005. Data were retrieved from the United Network of Organ Sharing (UNOS) database.

Results: One hundred and sixty patients underwent cadaveric kidney transplant. Intraoperative measurements including blood pressure and operative time were available in 94 patients of which 57 had immediate graft function (IGF) and 37 had SGF (defined as decline in serum creatinine (Cr) of <50% by day 3). In multivariate logistic regression analysis, intraoperative hypotension and prolonged operative time were additive independent risk factors for SGF. For every 5 mmHg increment decrease in blood pressure, the odds ratio (OR) for SGF was 1.28 (95% confidence interval (CI): 1.08-1.53) for systolic blood pressure (SBP), 1.38 (CI: 1.06-1.79) for diastolic blood pressure (DBP), and 1.51 (CI: 1.15-1.99) for mean arterial pressure (MAP). For every 30 min increase in operative time, the OR for SGF was 1.35 (CI: 1.07-1.71).

Conclusion: Intraoperative hypotension and prolonged operative time are independent risk factors for SGF in patients post-cadaveric kidney transplant.