Background: Delayed graft function (DGF) is a common early complication after kidney transplantation (KT) and is associated with various long-term adverse outcomes. Despite numerous studies on hemodynamic management, the optimal hemodynamic goals during KT remain unclear. In this retrospective study, we aimed to investigate if three mean artery pressure (MAP) thresholds (<= 75, 80, and 85 mmHg) that were commonly used in clinical practice were associated with DGF in adult patients undergoing KT. Methods: We extracted de-identified data on adult patients who underwent deceased donor KT from our Discovery Data Repository. DGF was defined as the requirement for dialysis within the first 7 days after transplantation. Three MAP thresholds (<= 75, 80, and 85 mmHg) and the duration of pressure below the three thresholds were recorded. Multivariable logistic analysis was used to identify risk factors for DGF. Results: We included 2301 adult KT patients. The mean age was 52.5 +/- 12.9 years and 59% were male. DGF occurred in 1066 patients (46.3%). Patients frequently experienced MAP <= 75, 80, and 85 mmHg (approximately 70%, 80%, and 90% of patients experienced 10 min of MAP <= 75, 80, and 85 mmHg, respectively). Patients with DGF spent significantly longer durations below the three MAP thresholds during surgery compared with those without DGF. Further analysis revealed that the minimal time spent on MAP <= 75, 80, and 85 mmHg that were significantly associated with DGF were 6, 23, and 37 min, respectively. After adjusting for nonhemodynamic risk factors (age, basiliximab administration, and urine output), prolonged exposure to the three MAP thresholds remained significant predictors for DGF (for MAP <= 75 mmHg, OR 1.257,95% CI 1.017-1.554, p = 0.034; MAP <= 80 mmHg, OR 1.220, 95% CI 1.018-1.463, p = 0.031; MAP <= 85 mmHg, OR 1.253, 95% CI 1.048-1.498, p = 0.013). Conclusion: Prolonged exposure to the three common MAP thresholds (<= 75, <= 75, 80, and 85 mmHg) occurred frequently during adult deceased donor KT and was associated with DGF.

Intraoperative Mean Arterial Pressure and Postoperative Delayed Graft Function in Kidney Transplantation: Evaluating Three Commonly Used Thresholds.