The influence of intraoperative hemodynamic parameters on the results of combined kidney and pancreas transplantation

Introduction. Reperfusion syndrome has been proven to impact the early results of simultaneous pancreas and kidney transplantation. The optimal values of hemodynamic parameters at the moment of reperfusion of the kidney graft and the pancreas graft have been the subject of discussion in relation to possible early complications and outcomes of simultaneous pancreas and kidney transplantation. This issue needs additional research.

The objective was to evaluate how the intraoperative hemodynamic parameters may influence early results of simultaneous pancreas and kidney transplantation.

Material and methods. The retrospective study was conducted to analyze the impact of intraoperative hemodynamic parameters on the early results of treatment in 83 patients who underwent simultaneous pancreas and kidney transplantation in the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2023.

Given the primary ROC analysis results, we allocated the patients into 2 groups, according to their mean arterial pressure (MAP) values at reperfusion. Group I consisted of patients with MAP<90 mmHg (n=21), group II included patients with MAP>90 mmHg (n=62). The characteristics of donors and recipients were comparable between the groups (p>0.05). The intraoperative hemodynamic parameters of the recipients (MAP, central venosus pressure, heart rate) were analyzed at the beginning of surgery, at reperfusion stages, at the time of making the interintestinal anastomosis, and on surgery completion; the incidence of postoperative complications was studied; the primary functions of the kidney and pancreas grafts were evaluated; the in-hospital graft and recipient survival rates were calculated.

Results. The median values of MAP (mm Hg) were significantly lower in group I compared to those in group II at all stages of surgery, except for the surgery beginning: 87 (86;87) mmHg versus 101 (97;104) mmHg at the time of the kidney graft reperfusion; 89 (83;95) mmHg versus 97 (93;102) mmHg at the time of the pancreatic graft reperfusion; 91 (85;95) mmHg versus 97 (89;99) mmHg at the time of making interintestinal anastomosis; 90 (82;100) mmHg and 103 (90;116) mmHg on surgery completion, respectively (p<0.05). The remaining hemodynamic parameters had no statistically significant differences between the groups (p>0.05). There were no statistically significant differences between the groups in the incidence of postoperative complications, either (p>0.05). The rate of primary kidney graft function was significantly higher in group II (96.8%; n=60) compared to group I (42.9%; n=11) (p<0.05). All recipients displayed a primary pancreatic graft function. The median hospital length of stay in group I days was statistically significantly longer compared to that of the patients in group II, making 45 (28.5;72) versus 34.5 (25;60) days, respectively (p<0.05).

The hospital survival rates of kidney grafts, pancreas grafts and recipients were significantly higher in patients of group II compared to those in patients of group I: 93.5% (n=58), 87.1% (n=54), and 96.8% (n=60) versus 57.1% (n=12), 57.1% (n=12), and 66.7% (n=14), respectively (p<0.05).

Conclusion. MAP 90 mmHg at the timepoint of reperfusion is a factor that has a statistically significant effect on the primary function of a kidney graft in the early postoperative period, associates with the increase in hospital survival rates of grafts and recipients at early stages after simultaneous pancreas and kidney transplantation.

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