Impact of Norepinephrine and Dopamine Infusion on Renal Arterial Resistive Index During Pre-Emptive Living Donor Kidney Transplantation: Propensity Score Matching Analysis

Overview

Journal Medicina (Kaunas)

Publisher MDPI

Specialty General Medicine

Date 2024 Jul 27

PMID 39064495

Authors

Jaewon Huh

Hyejin Kwon

Hunwoo Park

Sun Cheol Park

Sang Seob Yun

Min Suk Chae

Affiliations

Soon will be listed here.

Abstract

Living donor kidney transplantation (LDKT) is a crucial treatment for end-stage renal disease, with pre-emptive LDKT (transplantation before dialysis initiation) offering significant benefits in graft function and patient survival. The selection of a vasopressor during LDKT, particularly between norepinephrine and dopamine, and its impact on renal arterial hemodynamics measured using the renal arterial resistive index (RARI) is poorly understood. This retrospective observational cohort study enrolled 347 eligible pre-emptive LDKT recipients from the Seoul St. Mary's Hospital between January 2019 and June 2023. Utilizing propensity score matching (PSM), the patients were categorized into dopamine and norepinephrine groups to compare the effects of these vasopressors on the intraoperative RARI, postoperative estimated glomerular filtration rate (eGFR), and hourly urine output. The RARI was measured via the Doppler ultrasonography of the renal hilum and parenchyma post-graft vascular and ureteral anastomoses. The preoperative differences in the recipients' and donors' characteristics were mitigated following PSM. The dopamine group exhibited higher intraoperative RARI values at the renal hilum (0.77 ± 0.11 vs. 0.66 ± 0.13, < 0.001) and parenchyma (0.71 ± 0.1 vs. 0.6 ± 0.1, < 0.001) compared to those of the norepinephrine group. However, these differences were not statistically significant on postoperative day 7. The norepinephrine infusion adjusted for the propensity scores was associated with significantly lower odds of an RARI > 0.8 (hilum: OR = 0.214, 95% CI = 0.12-0.382, < 0.001; parenchyma: OR = 0.1, 95% CI = 0.029-0.348, < 0.001). The early postoperative outcomes showed a higher eGFR (day 1: 30.0 ± 13.3 vs. 25.1 ± 17.4 mL/min/1.73 m, = 0.004) and hourly urine output (day 1: 41.8 ± 16.9 vs. 36.5 ± 14.4 mL/kg/h, = 0.002) in the norepinephrine group. Furthermore, the long-term outcomes were comparable between the groups. Norepinephrine infusion during pre-emptive LDKT is associated with more favorable intraoperative renal arterial hemodynamics, as evidenced by a lower RARI and improved early postoperative renal function compared to those of dopamine. These findings suggest a potential preferential role for norepinephrine in optimizing perioperative management and early graft functions in LDKT recipients. Given the retrospective nature of this study, further prospective studies are needed to confirm these observations. Additionally, the study limitations include the potential for unmeasured confounding factors and the inability to determine causality due to its observational design.

References

Di Giantomasso D, Morimatsu H, May C, Bellomo R . Intrarenal blood flow distribution in hyperdynamic septic shock: Effect of norepinephrine. Crit Care Med. 2003; 31(10):2509-13. DOI: 10.1097/01.CCM.0000084842.66153.5A. View

Schmid S, Jungwirth B . Anaesthesia for renal transplant surgery: an update. Eur J Anaesthesiol. 2012; 29(12):552-8. DOI: 10.1097/EJA.0b013e32835925fc. View

Smudla A, Trimmel D, Szabo G, Fazakas J . Systolic Blood Pressure Pattern: The Tick Mark Signal of Delayed Renal Graft Function. Transplant Proc. 2019; 51(4):1226-1230. DOI: 10.1016/j.transproceed.2019.03.010. View

Martin C, Viviand X, Leone M, Thirion X . Effect of norepinephrine on the outcome of septic shock. Crit Care Med. 2000; 28(8):2758-65. DOI: 10.1097/00003246-200008000-00012. View

Liem Y, Weimar W . Early living-donor kidney transplantation: a review of the associated survival benefit. Transplantation. 2009; 87(3):317-8. DOI: 10.1097/TP.0b013e3181952710. View

Kasiske B, Snyder J, Matas A, Ellison M, Gill J, Kausz A . Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol. 2002; 13(5):1358-64. DOI: 10.1097/01.asn.0000013295.11876.c9. View

Radermacher J, Mengel M, Ellis S, Stuht S, Hiss M, Schwarz A . The renal arterial resistance index and renal allograft survival. N Engl J Med. 2003; 349(2):115-24. DOI: 10.1056/NEJMoa022602. View

Gordon A, Mason A, Thirunavukkarasu N, Perkins G, Cecconi M, Cepkova M . Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. JAMA. 2016; 316(5):509-18. DOI: 10.1001/jama.2016.10485. View

Regolisti G, Maggiore U, Cademartiri C, Belli L, Gherli T, Cabassi A . Renal resistive index by transesophageal and transparietal echo-doppler imaging for the prediction of acute kidney injury in patients undergoing major heart surgery. J Nephrol. 2016; 30(2):243-253. DOI: 10.1007/s40620-016-0289-2. View

10.

Segal J, Phang P, Walley K . Low-dose dopamine hastens onset of gut ischemia in a porcine model of hemorrhagic shock. J Appl Physiol (1985). 1992; 73(3):1159-64. DOI: 10.1152/jappl.1992.73.3.1159. View

11.

Pelayo J . Renal adrenergic effector mechanisms: glomerular sites for prostaglandin interaction. Am J Physiol. 1988; 254(2 Pt 2):F184-90. DOI: 10.1152/ajprenal.1988.254.2.F184. View

12.

Ricaurte L, Vargas J, Lozano E, Diaz L . Anesthesia and kidney transplantation. Transplant Proc. 2013; 45(4):1386-91. DOI: 10.1016/j.transproceed.2012.12.014. View

13.

Desjars P, Pinaud M, Bugnon D, Tasseau F . Norepinephrine therapy has no deleterious renal effects in human septic shock. Crit Care Med. 1989; 17(5):426-9. DOI: 10.1097/00003246-198905000-00010. View

14.

Chadban S, Ahn C, Axelrod D, Foster B, Kasiske B, Kher V . KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation. 2020; 104(4S1 Suppl 1):S11-S103. DOI: 10.1097/TP.0000000000003136. View

15.

Krol R, Chudek J, Kolonko A, Ziaja J, Pawlicki J, Wiecek A . Intraoperative resistance index measured with transsonic flowmeter on kidney graft artery can predict early and long-term graft function. Transplant Proc. 2011; 43(8):2926-9. DOI: 10.1016/j.transproceed.2011.08.019. View

16.

Cronin R, Erickson A, de Torrente A, McDonald K, Schrier R . Norepinephrine-induced acute renal failure: a reversible ischemic model of acute renal failure. Kidney Int. 1978; 14(2):187-90. DOI: 10.1038/ki.1978.106. View

17.

Radermacher J, Ellis S, Haller H . Renal resistance index and progression of renal disease. Hypertension. 2002; 39(2 Pt 2):699-703. DOI: 10.1161/hy0202.103782. View

18.

Papalois V, Moss A, Gillingham K, Sutherland D, Matas A, Humar A . Pre-emptive transplants for patients with renal failure: an argument against waiting until dialysis. Transplantation. 2000; 70(4):625-31. DOI: 10.1097/00007890-200008270-00016. View

19.

Kohei N, Sawada Y, Hirai T, Omoto K, Ishida H, Tanabe K . Influence of dialysis duration on the outcome of living kidney transplantation. Ther Apher Dial. 2014; 18(5):481-8. DOI: 10.1111/1744-9987.12169. View

20.

Enhesari A, Mardpour S, Makki Z, Mardpour S . Early ultrasound assessment of renal transplantation as the valuable biomarker of long lasting graft survival: a cross-sectional study. Iran J Radiol. 2014; 11(1):e11492. PMC: 3955852. DOI: 10.5812/iranjradiol.11492. View