Evaluation of the impact of intraoperative mean arterial pressure on the long-term results of simultaneous pancreas and kidney transplantation

Introduction. Simultaneous pancreas and kidney transplantation (SPKT) is an effective method of surgical treatment for patients suffering from type 1 diabetes mellitus (DM 1) in combination with end-stage renal disease as a result of diabetic nephropathy. Mean arterial pressure (MAP) of at least 90 mmHg improves hospital survival of grafts and recipients after SPKT. This paper presents the study investigating the effect of intraoperative MAP on long-term outcomes after SPKT.

Objective. The study objective was to evaluate the impact of the factor MAP at reperfusion in patients undergoing SPKT on the 15-year survival of kidney grafts, pancreas grafts and recipients.

Material and methods. A retrospective study of the effect of the MAP value at the stage of transplant reperfusion on the long-term treatment outcomes of 86 patients who underwent SPKT from 01.01.2007 to 12.31.2024 at the Kidney and Pancreas Transplantation Department of N.V. Sklifosovsky Research Institute for Emergency Medicine. There were 52 men (60%) and 34 women (40%), with a median age of 35 (31;39) years. Initially, the ROC analysis divided the patients into two groups: group I consisted of patients with MAP of <90 mmHg (n=23); group II consisted of patients with an average MAP of >90 mmHg (n=63). The primary point was to study the effect of a combination of factors, including the MAP value on reperfusion, on the 15–year survival rate of kidney grafts, pancreas grafts and recipients after SPKT. The end point was to analyze the 15–year survival rate of kidney grafts, pancreas grafts and recipients depending on the level of MAP during reperfusion.

Results. There was a statistically significant increase in the risk of a fatal outcome in recipients over the next 15 years after surgery, with a 5.66-fold increase in the duration of renal replacement therapy for each year (p=0.018), a 1.067-fold increase in BMI per 1 kg/m² (p=0.036), and a 1.782-fold decrease in the mean arterial pressure during reperfusion below 90 mmHg (p=0.021). The influence of the other factors was statistically insignificant. There was a statistically significant dependence of the risk of 15-year loss of a kidney graft (p=0.017), a pancreatic graft (p=0.042) and the lethality of recipients (p=0.005) on the level of mean arterial pressure during reperfusion. The 15-year survival rate of renal allografts was 42.3% in the group with MAP>90 mmHg, and 38.2% in the group with MAP<90 mmHg; the survival rate of pancreatic allografts was 60.8% and 48.9%, respectively; and the survival rate of recipients was 78.8% and 57.4%, respectively.

Conclusion. The MAP value of > 90 mmHg during the reperfusion is a statistically significant factor of the increase in the 15-year survival rates of a kidney graft (p=0.017), pancreas graft (p=0.042), and recipients (p=0.005) after SPKT.

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