EFFECT OF RECIPIENTS PERIOPERATIVE PARAME TERS TO THE OUTCOME OF KIDNEY-TRANSPLANTATION

Objective: to examine how to influence the preoperative recipient para meters of the transplanted kidney function in every day practice. Desi gn: retrospective, multifactorial analysis. Patients: 104 patients who underwent first cadaver kidney transplantation in our unit between Ja nuary and December in 1992 were involved in the study and were followe d up for another 2 years. The recipients were devided into 3 groups: G roup I: non functioning graft (n = 13); Group II: delayed graft functi on (n = 49); Group III: good graft function (n = 42). The grouping cri teria were: a) haemodialysis in the first 5 postoperative days, b) qua ntity of diuresis on the first postoperative day, c) serum creatinine difference between the first postoperative day compared to the preoper ative level. All of the parameters that we measure in our every day pr actice were involved in the examination. Results: The preoperative hem atocrit level differed signigicantly between Group III (0.30) and Grou p I and Group II (0.35 and 0.32 respectively, p < 0.05). Intraoperativ e significant differences were found between the different groups in s ystolic blood pressure, mean arterial pressure pulse-amplitude and in rate pressure product. The patients who had better postoperative kidne y function had higher blood pressure in the different phase of operati on than the patients who had postoperative kidney function problems. T he second warm ischaemic time in Group III was significantly shorter t han in the other two groups (Group III 37 min. vs. Group II 42 min. p < 0.05, vs. Group I 48 min. P < 0.001). The rejection rate was higher during the first 5 postoperative days in patients with non-functioning grafts (Group I 53% and Group II 24% vs. Group III 12%). The other ex amined parameters have not differed significantly. The observed kidney function differences in the early postoperative period between the 3 groups remained until the end of the next 2 years. Conclusions: Accord ing to our results the perioperative fluid-balance is one of the most important factors which may influence the success of the kidney transp lantation.