Introduction: Intraoperative hemodynamics are understood to influence the incidence of delayed graft function (DGF), defined as the need for dialysis within one week of transplant. However, there is limited evidence on best practices in anesthesia, pressor use, and fluid management in transplant recipients. We aim to characterize features of intra-operative anesthesia courses in order to determine whether such parameters associate with DGF. Methods: 671 kidney transplant recipients were included from surgeries performed at a single academic medical centre (Vancouver General Hospital, 2014-2020) based on availability of the anesthetic record, operative note, and discharge summary. The anesthetic records comprised medications and fluids administered (including quantities, timing, and rate of administration), and hemodynamics throughout the procedure, in 5 minute intervals. Information on major time points such as timing of vascular clamp, anastomosis, etc. were obtained from post-operative notes. Repeated univariate logistic regression after feature extraction of time-series variables was used for hypothesis testing. Results: 142 DGF events were captured in our cohort (62/294 NDD; 80/167 DCD; 11/210 LD). Notably, diastolic blood pressure and mean arterial pressure throughout the operation were substantially lower in DGF recipients (average DBP: p=0.001, average MAP: p=0.002). Limiting analysis to DCD/NDD grafts, intraoperative hypotension expressed as the lowest intraoperative MAP post-anastomosis was significantly associated with DGF incidence, with greater hypotension susceptibility noted in DCD over NDD grafts. An interaction logistic terms regression analysis between lowest post-anastomosis MAP and pressor use was also performed, which indicated that DGF incidence in both DCDs and NDDs was lower in low-MAP patients ( <65mmHg) when pressors were used, but that DGF incidence was higher in patients where pressors were used if the lowest intra-operative MAP was above 65 mmHg. Conclusions: We have collated a highly granular transplant anesthesia dataset depicting a preliminary view into intraoperative hemodynamics and decision-making. Future steps include further interrogation of the data and prospective study to inform goal-directed anesthesia. SOURCE OF Funding: None.
