P1717OUTCOMES OF INCREASED INTRA-ABDOMINAL PRESSURE AFTER KIDNEY TRANSPLANTATION

• Published in: Nephrology, dialysis, transplantation Vol. 35; no. Supplement_3
• Main Authors: Coca, Armando, Arias-Cabrales, Carlos, Pérez-Sáez, Maria José, Gonzalez, Pablo, Acosta-Ochoa, Isabel, Bustamante-Munguira, Elena, Rollan, Maria Jesus, Mendiluce, Alicia, Pascual, Julio, Bustamante-Munguira, Juan
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-06-2020
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfaa142.P1717

Abstract
Background and Aims
Increased intra-abdominal pressure (IAP) is commonly found among post-surgical patients and can induce organ dysfunction. However, its prevalence and impact after kidney transplantation have not been adequately described. We aimed to study the prevalence of increased IAP after kidney transplantation and its consequences on transplant outcomes.
Method
IAP was prospectively measured in 121 kidney transplant recipients every 8h during the first 72h after surgery using the urinary bladder technique (UnoMeter Abdo-Pressure kit). Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Grading of intra-abdominal hypertension was defined according to WSACS guidelines. Patients were followed for at least 12 months or until graft failure or death. The study was approved by the local ethics committee and informed consent was obtained in all cases.
Results
24h-IAP was 12.6±3.5 mmHg. 84.2% of subjects presented with intra-abdominal hypertension during the first 72h after kidney transplantation. Body mass index (OR: 1.35, 95% CI 1.12-1.63; P=0.002), male sex (OR: 3.34, 95% CI 1.1-10.3; P=0.032) and hemodialysis as renal replacement therapy before transplantation (OR: 4.35, 95% CI 1.32-14.4; P=0.016) were independent determinants of intra-abdominal hypertension. IAP was an independent risk factor for delayed graft function (*model adjusted for recipient age, sex, history of previous kidney transplants, recipient comorbidities, donor terminal serum creatinine and comorbidities, number of HLA mismatches >4, cold ischemia time and donation after cardiac death status), graft failure and death (**model adjusted for all variables included in the previous model plus delayed graft failure) (Figure).
Conclusion
Increased IAP was highly common after transplant surgery and was associated with higher rates of delayed graft function, graft failure and death. Routine IAP monitoring should be considered after transplantation to facilitate early identification of complications and initiation of the appropriate treatment to stop its effects.
No IAH
Grade I IAH
Grade II IAH
Grade III IAH
p-value
N
21
68
27
5
Age, years
61 (46-68)
62 (52-71)
58 (52-68)
68 (50-73)
0.3
Male sex, n (%)
8 (38.1)
46 (67.6)
22 (81.5)
5 (100)
0.005
Dialysis vintage, months
21 (11-47.5)
18.5 (10-32.8)
29 (11-54)
30 (22-53.5)
0.367
BMI, kg/m2
22.9±3.8
25.8±3.5
27.3±3.2
28.9±5.9
<0.001
PKD, n (%)
3 (14.3)
15 (22.1)
4 (14.8)
1 (20)
0.795
PD as RRT, n (%)
13 (61.9)
28 (41.2)
9 (33.3)
0 (0)
0.048
First renal transplant, n (%)
16 (76.2)
62 (91.2)
22 (81.5)
3 (60)
0.108
Hypertension, n (%)
17 (81)
62 (91.2)
24 (88.9)
5 (100)
0.498
Diabetes, n (%)
2 (9.5)
14 (20.6)
5 (18.5)
2 (40)
0.428
Age (donor), years
54 (35.5-62)
66 (54-72)
58 (49-72)
69 (50-78)
0.046
Male sex (donor), n (%)
15 (71.4)
42 (61.8)
18 (66.7)
4 (80)
0.748
SCr (donor), mg/dl
0.75 (0.64-0.89)
0.79 (0.68-0.93)
0.76 (0.68-1)
0.93 (0.71-1.02)
0.751
DCD, n (%)
1 (4.8)
1 (1.5)
2 (7.4)
0 (0)
0.485
CIT, hours
14 (12-19)
16 (13-18)
16 (13-19)
18 (15-23)
0.622
HLA mismatches, number
4 (4-6)
4 (4-5)
4 (4-5)
3 (2-5)
0.338
OR
95% Confidence Interval
p-value
Lower
Upper
Delayed graft function; 24h-IAP
1.214
1.072
1.375
0.002
Graft failure or recipient death**
OR
95% Confidence Interval
p-value
Lower
Upper
At discharge; 24h-IAP
1.363
1.065
1.745
0.014
At 6 months; 24h-IAP
1.199
1.017
1.415
0.031
At 12 months; 24h-IAP
1.244
1.045
1.481
0.014
BMI, body mass index. CIT, cold ischemia time. DCD, donation after cardiac death. HLA, human leukocyte antigen. IAH, intra-abdominal hypertension. IAP, intra-abdominal pressure. OR, odds ratio. PD, peritoneal dialysis. PKD, polycystic kidney disease. RRT, renal replacement therapy. SCr, serum creatinine.