title: Intraoperative Pleth Variability Index Is Linked to Delayed Graft Function After Kidney Transplantation.
abstract: BACKGROUND
  Delayed graft function (DGF) is an early postoperative complication of kidney transplantation (KT) predisposing to acute rejection and lower graft survival. Intraoperative arterial hypotension and hypovolemia are associated with DGF. Central venous pressure (CVP) is used to estimate volemia but its reliability has been criticized. Pleth variability index (PVI) is a hemodynamic parameter predicting fluid responsiveness. The aim of this study was to examine the relationship between intraoperative PVI and CVP values and the occurrence of DGF.
  
  
  METHODS
  This was a prospective, noninterventional, observational, single-center study. All consecutive patients with KT from deceased donors were included. Recipients received standard, CVP, and PVI monitoring. Intraoperative hemodynamic parameters were recorded from recipients at 5 time points during KT.
  
  
  RESULTS
  Forty patients were enrolled. There was a poor correlation between PVI and CVP values (r2= 0.003; P = .44). Immediate graft function and DGF patients had similar hemodynamic values during KT, with the exception of PVI values, which were significantly higher in the DGF group. In particular, a PVI >9% before unclamping of the renal artery was the only predictive parameter of DGF in our multivariate analysis (P = .02).
  
  
  CONCLUSIONS
  This study suggests that PVI values >9% during KT are associated with the occurrence of DGF.
authors: Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France. Electronic address: olivier.collange@chru-strasbourg.fr.
authors: O
authors: O
authors: Collange
authors: Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: L
authors: L
authors: Jazaerli
authors: Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Service de Chirurgie Vasculaire et de Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: A
authors: A
authors: Lejay
authors: Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: C
authors: C
authors: Biermann
authors: Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: S
authors: S
authors: Caillard
authors: Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: B
authors: B
authors: Moulin
authors: Service de Chirurgie Vasculaire et de Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: N
authors: N
authors: Chakfe
authors: Département de Santé Publique, Secteur Méthodologie et Biostatistique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: F
authors: F
authors: Severac
authors: Département de Santé Publique, Secteur Méthodologie et Biostatistique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: M
authors: M
authors: Schaeffer
authors: Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
authors: P-M
authors: PM
authors: Mertes
authors: Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
authors: A
authors: A
authors: Steib
mesh_terms: D000328:Adult; D002496:Central Venous Pressure / Q000502:physiology; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000706:statistics & numerical data*; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D010991:Plethysmography / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors