Impact of intra-abdominal pressure on early kidney transplant outcomes

Abstract

Increased intra-abdominal pressure (IAP) is common among post-surgical patients and may cause organ dysfunction. However, its impact after kidney transplantation on early postoperative complications and graft recovery remains unclear. We designed a prospective, observational cohort study to describe the prevalence and determinants of IAP, as well as its effect on delayed graft function, postoperative complications, and graft recovery. IAP was measured in 205 kidney transplant recipients every 8 h during the first 72 h after surgery using the urinary bladder technique. Intra-abdominal hypertension was defined as IAP ≥ 12 mmHg. Patients were followed for 6 months or until graft failure/death. Mean IAP was 12 ± 3.3 mmHg within the first 24 h. 78% of subjects presented with intra-abdominal hypertension during the first 72 h. Increased IAP was associated with higher renal resistive index [r = 0.213; P = 0.003] and lower urine output [r = − 0.237; P < 0.001]. 72 h mean IAP was an independent risk factor for delayed graft function [OR: 1.31; 95% CI: 1.13–1.51], postoperative complications [OR: 1.17; 95% CI: 1.03–1.33], and absence of graft function recovery [HR for graft function recovery: 0.94; 95% CI: 0.88–0.99]. Increased IAP was highly prevalent after transplantation and was independently associated with delayed graft function, postoperative complications, and absence of graft function recovery. Routine IAP monitoring should be considered post-transplantation to facilitate early recognition of relevant complications.

Continuous intra-abdominal pressure: is it ready for prime time?

“…7 Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA. 8 Outcomes Research Consortium, Cleveland, OH, USA. 9 Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.…”

“…3 and 4) [ 1 ]. Coca et al reported data from 205 kidney transplant patients where intermittently measured high IAP was common and associated with delayed graft function, postoperative complications, and absence of graft function recovery [ 8 ]. In addition, IAP is a prognostic marker when measured during exploratory laparotomy in surgical patients, with higher numbers associated with mortality, a higher SOFA score and prolonged ileus.…”

Intra-abdominal hypertension and abdominal compartment syndrome

“…In 205 patients undergoing kidney transplantation, IAH developed in 78% of patients during the first 3 days after surgery [9]; mean IAPs were 12 mmHg. Higher IAP was associated with higher resistance index and lower urinary output, and the 72 h mean IAP was an independent predictor of delayed graft function, postoperative complications as well as absence of graft recovery.…”