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In the last years the hemodynamic monitoring methods were moving to less invasive modalities. The Swan Ganz catheter has been replaced in most cases by other methods with suitable validation. Within them, the bioimpedance cardiography (BC) allows a reliable measurement for the cardiac output and derived variables. It has been used in critical ill patients, in emergency department for classification of dyspnea and in different post-surgical scenarios. However, there are not studies describing hemodynamic changes in the immediate post-transplant period using or not BC.
OBJETIVE: To describe hemodynamic variables in the 24 to 48 hours of the post-surgical period (POP) in deceased kidney transplant (DKT) recipients using BC, classical variables and echocardiogram.METHODS: Prospective observational study. We recorded classical hemodynamic variables: mean arterial pressure, cardiac frequency, diuresis, fluid balance, central venous pressure and weight; echocardiogram variables: Ejection fraction (EF), TAPSE, E/e´ratio, pulmonary artery systolic pressure (PASP), contractility and E/A ratio; and finally BC variables: TCF (Total Chest Fluid Content), SVRI (Systemic Vascular Resistance Index), AC (Arterial Complacency), AE (Arterial Elastance) and CI (Cardiac Index) in the 24 to 48 hours of the POP. Between 2021 to 2023 a total of 31 DKT patients were included in the study. We divided this cohort in 2 groups according to delay graft function (DGF), defined as dialysis requirement in the first week after transplantation or serum creatinine above 2,5 mg/dl at 7 days of the POP. We compared hemodynamic and echocardiogram variables.
Mean age was 53,65 years, 67,74% were male and 90,3% had hypertension. The median time on dialysis was 3,49 years. 64,5% (20) had DGF. KDPI score was 57% with a median of Cold Ischemia Time of 19,28 hours. Thymoglobulin, corticosteroids and Mycophenolic acid were used in the first 48 hours, according to our Institutional protocol. There were no differences in the intra operatory variables such as crystalloid volume infused, dose of noradrenaline or transfusional requirement. No differences were found in echocardiogram variables neither. The CI (4,17 vs 2,4 p=0,76) and AC (2,15 vs 1,12 p=0,63) were greater with a lesser SVRI (959 vs 1666 p=0,63) in receptors without DGF vs DGF and this tendence remained in the 48 hours of the POP but without statical significance. There were statistically significant differences in total fluid balance at 24 hours (400 vs 795 ml, p=0,004) and diuresis (2400 vs 685 ml, p<0,001) that continued in the 48 hours of the POP, with a consequent weight gain in DGF patient’s vs no DGF ones (4,05 vs 1,5 p=0,123).
DGF patients had less AC, CI, diuresis with greater weight gain, positive fluid balance and SVRI than no DGF patients. The hemodynamic findings could be explained for greater sympathetic activation in DGF receptors with consequent less kidney perfusion. A larger sample is needed to prove this hypothesis and find the causes.