Influence of alprostadil on the dynamics of blood flow resistance index and renal graft function in the early postoperative period

Aim. To evaluate the effect of continuous intravenous infusion of alprostadil solution on the dynamics of the peripheral resistance to arterial blood flow and renal graft function in the early postoperative period.

Material and methods. From June 2018 to May 2022, 278 kidney transplants from a deceased donor were performed at the City Clinical Hospital n.a. S.P. Botkin. In 179 recipients operated from June 2018 to May 2021, we evaluated the significance of the intraoperatively determined resistance index of blood flow in the segmental arteries of the renal graft as a predictor of the development of its delayed function. The study of the effect of alprostadil included 32 patients divided into 2 groups comparable in patient age, gender, body mass index. The resistance index in both groups was more than 0.85. In the second group patients received a continuous intravenous infusion of alprostadil solution in the first 3 days after surgery.

Results. Retrospectively we found that in patients with a high resistance index (more than 0.85), the risk of developing delayed graft function was 6.9 times higher, that was statistically significant (p=0.001). In the alprostadil group, a delayed graft function developed in 5 of 18 patients (27.8%), compared with the control group, where delayed graft function developed in 9 of 14 (64.3%) patients, however, without reaching the level of statistical significance (p=0.072). The median time to normalization of graft function in group II was 4 (interquartile range: 3–4) days, while in group I it was 7 (interquartile range: 5–8) days (p=0.05). The median hospital length of stay in the alprostadil group was significantly lower than in the control group and amounted to 13 (interquartile range: 8–15) versus 17 (interquartile range: 15–19) days (p=0.032).

Conclusion. The use of continuous intravenous infusion of alprostadil solution after kidney transplantation in patients with a high intraoperative resistance index can safely and effectively lead to a decrease in resistance index to normal rates, accelerate the recovery of graft function and significantly reduce the incidence of delayed graft function. However, further research is needed.

1. Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V, et al. KDIGO Clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation. 2020;104(1):S11–S103. PMID: 32301874 https://doi.org/10.1097/TP.0000000000003136

2. Al Otaibi T, Ahmadpoor P, Allawi AA, Habhab WT, Khatami MR, Nafar M, et al. Delayed graft function in livingdonor kidney transplant: a middle eastern perspective. Exp Clin Transplant. 2016;14(1):1–11. PMID: 26862818 http://dx.doi.org/10.6002/ect.2015.0146

3. Lentine KL, Smith JM, Hart A, Miller J, Skeans MA, Larkin L, et al. OPTN/ SRTR 2020 Annual data report: kidney. Am J Transplant. 2022;22(Suppl 2):21–136. PMID: 35266618 https://doi.org/10.1111/ajt.16982

4. Mannon RB. Delayed graft function: The AKI of kidney transplantation. Nephron. 2018;140(2):94–98. PMID: 30007955 https://doi.org/10.1159/000491558

5. Bahl D, Haddad Z, Datoo A, Qazi YA. Delayed graft function in kidney transplantation. Curr Opin Organ Transplant. 2019;24(1):82–86. PMID: 30540574 https://doi.org/10.1097/MOT.0000000000000604

6. Mannon RB. Acute kidney injury in kidney transplants: new insights. Nephron. 2019;143(3):193-196. PMID: 31096218 https://doi.org/10.1159/000500550

7. Melih KV, Boynuegri B, Mustafa C, Nilgun A. Incidence, risk factors, and outcomes of delayed graft function in deceased donor kidney transplantation. Transplant Proc. 2019;51(4):1096–1100. PMID: 31101179 https://doi.org/10.1016/j.transproceed.2019.02.013

8. Kernig K, Albrecht V, Dräger DL, Führer A, Mitzner S, Kundt G, et al. Predictors of delayed graft function in renal transplantation. Urol Int. 2022;106(5):512–517. PMID: 34915519 https://doi.org/10.1159/000520055

9. Bogaert S, Peeters P, Suchonos N, Decruyenaere A, Decruyenaere P, Vermassen F, et al. WITHDRAWN: impact on delayed graft function of the renal resistive index in the immediate postoperative period after kidney transplantation: a cohort analysis. Transplant Proc. 2020:S0041–1345(19)31053–X. PMID: 32703673 https://doi.org/10.1016/j.transproceed.2019.09.004

10. Cano H, Castañeda DA, Patiño N, Pérez HC, Sánchez M, Lozano E, et al. Resistance index measured by doppler ultrasound as a predictor of graft function after kidney transplantation. Transplant Proc. 2014;46(9):2972–2974. PMID: 25420803 https://doi.org/10.1016/j.transproceed.2014.07.001

11. Bellos I, Perrea DN, Kontzoglou K. Renal resistive index as a predictive factor of delayed graft function: a metaanalysis. Transplant Rev. 2019;33(3):145–153. PMID: 30954370 https://doi. org/10.1016/j.trre.2019.03.003

12. Thebridge L, Fisher C, Puttaswamy V, Pollock C, Clarke J. Systematic review of intra-operative duplex scanning during renal transplantation. Australas J Ultrasound Med. 2022;25(1):42–50. PMID: 35251902 https://doi. org/10.1002/ajum.12289

13. Klein A, Cofer J, Pruett T, Thuluvath PJ, McGory R, Uber L, et al. Prostaglandin E1 administration following orthotopic liver transplantation: A randomized prospective multicenter trial. Gastroenterology. 1996;111(3):710–715. PMID: 8780576 https://doi.org/10.1053/gast.1996.v111.pm8780576

14. Russian transplantological sosciety. Transplantatsiya pecheni, nalichie transplantirovannoy pecheni, otmiranie i ottorzhenie transplantata pecheni. Klinicheskie rekomendatsii. 2020. Available at: https://transpl.ru/upload/medialibrary/0cb/0cbeb29cc22aa941f9d1a9f4ed11dd23.pdf [Accessed September 29, 2022]. (In Russ.).

15. Kornberg A, Schotte U, Kupper B, Hommann M, Scheele J. Impact of selective prostaglandin E1 treatment on graft perfusion and function after liver transplantation. Hepatogastroenterology. 2004;51(56):526–531. PMID: 15086195

16. Lironi C, McLin VA, Wildhaber BE. The Effect and safety of prostaglandin administration in pediatric liver transplantation. Transplant Direct. 2017;3(6):е163. PMID: 28620647 https://doi.org/10.1097/TXD.0000000000000682

17. Rzhevskaya ON, Tarabarko NV, Pinchuk AB, Yepifanov SYu, Storozhev RV. Vasaprostane in the complex treatment of acute tubular necrosis after kidney transplantation. Russian Journal of Transplantology and Artificial Organs. 2006;(5):21–23. (In Russ.).

18. Shmarina NV, Dmitriev IV, Khubutiya BZ, Pinchuk AV. Transplantation of expanded criteria kidney grafts to elderly recipients in the N.V. Sklifosovsky Research Institute for Emergency Medicine. Transplantologiya. The Russian Journal of Transplantation. 2018;10(3):175–184. (In Russ.) https://doi.org/10.23873/2074-0506-2018-10-3175-184

19. Khubutiya BZ, Rzhevskaya ON, Lisenok AA. Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history. Transplantologiya. The Russian Journal of Transplantation. 2021;13(2):165–178. (In Russ.)

20. Querard AH, Foucher Y, Combescure C, Dantan E, Larmet D, Lorent M, et al. Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis. Transpl Int. 2016;29(4):403–415. PMID: 26756928 https://doi.org/10.1111/tri.12736