Prospective assessment of the impact of intraoperative diuretics in kidney transplant recipient surgery

Background: The use of intraoperative diuretics, such as furosemide or mannitol, during kidney transplantation has been suggested to reduce the rate of delayed graft function (DGF). The evidence base for this is sparse, however, and there is substantial variation in practice. We sought to evaluate whether the use of intraoperative diuretics during kidney transplantation translated into a reduction in DGF. Methods: We conducted a cohort study evaluating the use of furosemide or mannitol given intraoperatively before kidney reperfusion compared with control (no diuretic). Adult patients receiving a kidney transplant for end-stage renal disease were allocated to receive furosemide, mannitol, or no diuretic. The primary outcome was DGF; secondary outcomes were graft function at 30 days and perioperative changes in potassium levels. Descriptive and comparative statistics were used where appropriate. Results: A total of 162 patients who received a kidney transplant from a deceased donor (either donation after neurologic determination of death or donation after circulatory death) were included over a 2 -year period, with no significant between-group differences. There was no significant difference in DGF rates between the furosemide, mannitol, and control groups. When the furosemide and mannitol groups were pooled (any diuretic use) and compared with the control group, however, there was a significant improvement in the odds that patients would be free of DGF (odds ratio 2.10, 95% confidence interval 1.06-4.16, 26% v. 44%, p = 0.03). There were no significant differences noted in any secondary outcomes. Conclusion: This study suggests the use of an intraoperative diuretic (furosemide or mannitol) may result in a reduction in DGF in patients undergoing kidney transplantation. Further study in the form of a randomized controlled trial is warranted. Contexte: Il a t sugg r que le recours aux diur tiques perop ratoires, comme le furos mide ou le mannitol, durant la transplantation r nale pourrait r duire le taux de retard la reprise de fonction du greffon. Cependant, il existe peu de donn es probantes appuyant cette hypoth se, et une grande variabilit dans la pratique. Nous avons voulu valuer si le recours aux diur tiques perop ratoires durant la transplantation r nale entra nait une diminution des retards de reprise de fonction. M thodes: Nous avons men une tude de cohorte valuant l'administration per-op ratoire de furos mide ou de mannitol avant la reperfusion du rein, comparativement un groupe t moin (aucun diur tique). Des patients adultes atteints d'une insuffisance r nale chronique terminale recevant une transplantation r nale ont t r partis en 3 groupes: furos mide, mannitol, ou aucun diur tique. Le r sultat principal tait le retard la reprise de fonction du greffon; les r sultats secondaires taient la fonction du greffon 30 jours et la variation p riop ratoire du taux de potassium. Des statistiques descriptives et comparatives ont t utilis es, le cas ch ant. R sultats: Au total, 162 patients ayant re u une greffe du rein d'un donneur d c d (don apr s un diagnostic de d c s neurologique ou de d c s cardiocirculatoire) ont t inclus dans l' tude sur une p riode de 2 ans, sans diff rences significatives entre les groupes. Aucune diff rence significative de taux de retard la reprise de fonction n'a t observ e entre les groupes furos mide, mannitol, et aucun diur tique. Consid r s ensemble, les groupes furos mide et mannitol (tous diur tiques confondus) pr sentaient toutefois une am lioration significative du taux de retard comparativement au groupe t moin (rapport de cotes 2,10, intervalle de confiance 95% 1,06-4,16, 26% c. 44%, p = 0,03). On n'a not aucune diff rence statistiquement significative entre les 2 groupes pour ce qui est des param tres secondaires. Conclusion: Cette tude semble indiquer que le recours aux diur tiques perop ratoires (furos mide ou mannitol) pourrait entra ner une r duction du taux de retard la reprise de fonction du greffon chez les personnes ayant subi une transplantation r nale. L'ex cution d'un essai clinique randomis est de mise.
Kidney transplantation has provided decades of successful treatment for end-stage renal disease. Delayed graft function (DGF) is a condition defined in the modern era as a requirement for dialysis within [...]