Kidney transplantation and perioperative complications: a prospective cohort study
Transplante renal e complicações perioperatórias: um estudo de coorte prospectivo
Priscila Sartoretto Dal Magro, Gisele Meinerz, Valter Duro Garcia, Florentino Fernandes Mendes, Maria Eugenia Cavalheiro Marques, Elizete Keitel
Abstract
Background
Kidney transplant recipients face complex perioperative challenges due to comorbidities from chronic kidney disease. This study aimed to assess perioperative complications in kidney transplant recipients and evaluate the association between the Charlson Comorbidity Index (CCI) and complication severity using the Clavien-Dindo (CD) classification.
Methods
A prospective cohort study conducted at a tertiary hospital in South Brazil from September 2020 to March 2022, including 230 adult kidney transplant recipients. Data on demographics, comorbidities, and complications were collected. Complications were categorized using the CD scale, and their relationship with CCI was analyzed using univariate and multivariate Cox regression.
Results
Mean age was 49.2 ± 12.7 years, with 58.7% male recipients. The mean CCI score was 3.65 ± 1.5 points. Intraoperative complications occurred in 10.9% of patients, with notable issues including bleeding and airway difficulties. In the immediate postoperative period, 9.1% required urgent dialysis. In the 30-day follow-up, 57.8% had delayed graft function, 21.7% infections, 11.3% had vascular complications, and the mortality was 1.7%. CCI was not a significant predictor of severe complications; however, congestive heart failure was strongly associated with severe complications (HR = 6.6 95% CI 2.6–6.7, p < 0.001).
Conclusions
Despite a low overall comorbidity profile, kidney transplant recipients faced significant perioperative challenges. The lack of a significant association between the CCI score and severe complications suggests that traditional risk assessment tools may not fully capture the risks specific to the early postoperative period in kidney transplantation, and future research should focus on developing more refined risk assessment models for chronic kidney disease patients.
Keywords
Resumo
Introdução
Receptores de transplante renal enfrentam desafios perioperatórios complexos devido a comorbidades da doença renal crônica. Este estudo teve como objetivo avaliar complicações perioperatórias em receptores de transplante renal e avaliar a associação entre o Índice de Comorbidade de Charlson (ICC) e a gravidade das complicações usando a classificação de Clavien-Dindo (CD).
Métodos
Um estudo de coorte prospectivo conduzido em um hospital terciário no sul do Brasil de setembro de 2020 a março de 2022, incluindo 230 receptores adultos de transplante renal. Dados sobre dados demográficos, comorbidades e complicações foram coletados. As complicações foram categorizadas usando a escala CD, e sua relação com o ICC foi analisada usando regressão de Cox univariada e multivariada.
Resultados
A idade média foi de 49,2 ± 12,7 anos, com 58,7% de receptores do sexo masculino. A pontuação média do ICC foi de 3,65 ± 1,5 pontos. Complicações intraoperatórias ocorreram em 10,9% dos pacientes, com problemas notáveis, incluindo sangramento e dificuldades nas vias aéreas. No pós-operatório imediato, 9,1% necessitaram de diálise urgente. No acompanhamento de 30 dias, 57,8% apresentaram função retardada do enxerto, 21,7% infecções, 11,3% complicações vasculares e a mortalidade foi de 1,7%. O ICC não foi um preditor significativo de complicações graves; no entanto, a insuficiência cardíaca congestiva foi fortemente associada a complicações graves (HR = 6,6 IC 95% 2,6–6,7, p < 0,001).
Conclusões
Apesar de um baixo perfil geral de comorbidade, os receptores de transplante renal enfrentaram desafios perioperatórios significativos. A falta de uma associação significativa entre a pontuação do ICC e complicações graves sugere que as ferramentas tradicionais de avaliação de risco podem não capturar totalmente os riscos específicos do período pós-operatório inicial no transplante renal, e pesquisas futuras devem se concentrar no desenvolvimento de modelos de avaliação de risco mais refinados para pacientes com doença renal crônica.
Palavras-chave
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Submitted date:
16/12/2023
Accepted date:
27/08/2024
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