Abstract: PO2406
Vasopressin Use After Deceased Donor Kidney Transplant (DDKT): Patient Characteristics, Graft Function, and Clinical Outcomes
Session Information
- Clinical and Immunologic Predictors of Post-Transplant Outcomes
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Jan, Muhammad Yahya, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Goggins, William, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Yaqub, Muhammad S., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Taber, Tim E., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Mishler, Dennis P., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Moorthi, Ranjani N., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Eadon, Michael T., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Chen, Jeanne, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Sharfuddin, Asif A., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
Vasopressin (AVP) is used for maintenance of volume status and hemodynamics due to its vasopressor activity with less arrhythmogenic and ischemic potential. It has catecholamine sparing effect. AVP has been shown to improve rates of deceased organ donation. We studied AVP use post DDKT for improving hemodynamics with resultant effect on graft function and clinical course.
Methods
A retrospective chart review was done on patients >18 years of age who required AVP post operatively after a DDKT over 5 years (2012-2017). Recipient, donor characteristics, intraoperative parameters, hospital/ICU stay, graft failure, patient survival, and hyponatremia during first 48 hours were reviewed.
Results
A total of 43 patients fulfilled inclusion criteria. Refer to Table for summary. Total of 5 patients (11.6%) required dialysis, 3 of whom received donation of kidney after cardiac death. There were 3 deaths during the first 12 months (6.9%). Mean cold and warm ischemia time were 32.5±12.9 hours and 39.2 ±10.2 minutes, respectively. Mean time to start AVP was 6.8 hours post operatively and mean duration of AVP use was 43.2 with a median of 30 hours. 72.1% of patient also required dopamine. Mean hospital stay was 14.5 days and length of ICU stay was 5.4 days. Mean creatinine at day 7 was 4.0 ± 4.2 mg/dl. There was no incidence of hyponatremia during the first 48 hours. Graft survival was 72% at median follow up time of 7.2 years.
Conclusion
Patient requiring AVP post DDKT have unique characteristics - fewer anti-HTN medications and longer time on dialysis prior to transplant. A longer than median hospital length of stay was noted. To our knowledge this is the first study reviewing AVP use post DDKT. Future studies are needed to compare characteristics and outcomes with patients’ who did not require AVP post DDKT.
Recipient Characteristics and Intraoperative BP (n=43)
| Gender: Male 51.2% Female 48.8% | Age: Mean 58.6 Years (± 12.3) |
| Race: Caucasian 60.5% African American 39.5% | BMI: Mean 30.2 kg/m2 (± 5.3) |
| Atrial Fibrillation*: 14% | Ejection Fraction*: Mean 60.2% (± 8.4 ) |
| Diastolic Heart Failure*: 26.2% | Pulmonary hypertension*: 27.9% |
| Anti-Hypertensive medication: Median 1.0 (0-6) | Midodrine pre-transplant: 18.6% |
| Time on dialysis: Mean 6.7 Years (± 4.12) | Dialysis Modality: HD 83.7%, PD 14% |
| Etiology of ESRD: Glomerulonephritis: (30.2%) Hypertension: (27.9%) Diabetes Mellitus: (25.5%) | Mean Systolic Max/Min BP in OR: 138.8 ± 22.4/ 91.7 ± 16 Mean Diastolic Max/ Min BP in OR: 69.6 ±13.7/ 42.8 ± 9.5 |
*prior to DDKT. OR=operating room.