Association Between Perioperative Hypotension and Graft Function in Kidney Transplantation

Introduction: The impact of perioperative hypotension on graft function after kidney transplantation (KT) has not been well-described; however, it may be expected to negatively impact posttransplant outcomes. Methods: We conducted a retrospective cohort study of adult patients undergoing KT in a multiprovincial renal program from 2006 to 2019. Using multivariable logistic regression, we assessed the association of intraoperative hypotension (IOH; systolic blood pressure (sBP) ≤ 90 mm Hg within the final hour of surgery) and postoperative hypotension (POH; occurring within the first 2 postoperative days) with delayed graft function (DGF). In secondary analyses, we used adjusted logistic regression or Cox proportional hazards models to assess the impact of hypotension on prolonged length of stay (LOS), death-censored graft loss (DCGL), and all-cause graft loss (ACGL). Results: Of the 1020 patients included, 209 (20.5%) and 112 (11.0%) had IOH and POH, respectively. POH was associated with DGF (adjusted odds ratio [aOR]: 4.01, 95% CI: 2.24-7.19), LOS (aOR: 2.82, 95% CI: 1.69-4.71), DCGL (adjusted hazard ratio [aHR]: 3.37, 95% CI: 1.29-8.84), and ACGL (aHR: 2.21, 95% CI: 1.26-3.89). IOH was not associated with DGF (aOR: 1.02, 95% CI: 0.61-1.72) or LOS (aOR: 1.19, 95% CI: 0.81-1.76), but was associated with reduced DCGL (aHR: 0.32, 95% CI: 0.13-0.82) and ACGL (aHR: 0.59, 95% CI: 0.36-0.98). There was a trend toward greater susceptibility to POH in male than female recipients; however, this did not meet statistical significance. Conclusion: Overall, POH, but not IOH, was associated with an increased risk of DGF, prolonged LOS, DCGL, and ACGL.