Background
Methods
Ethical considerations
Study population
Surgery and anesthesia
ITMB intervention
Estimated glomerular filtration rate
Clinical variables
Statistical analyses
Results
Perioperative baseline findings in living donors undergoing laparoscopic nephrectomy
Living donors | |
---|---|
n | 366 |
Preoperative characteristics | |
Sex (male) | 154 (42.1%) |
Age (years) | 46 ± 12 |
Body mass index ≥25 kg/m2 | 122 (33.3%) |
Hypertension | 21 (5.7%) |
Remnant kidney volume (mL) | 176.0 ± 35.4 |
Estimated glomerular filtration rate (mL/min/1.73 m2) | |
≥ 90 | 197 (53.8%) |
89–60 | 169 (46.2%) |
Laboratory variables | |
White blood cell count (× 109/L) | 6.1 ± 1.7 |
Hemoglobin (g/dL) | 14.1 ± 1.5 |
Platelet count (× 109/L) | 250.9 ± 58.0 |
Glucose (mg/dL) | 97 ± 10 |
Albumin (g/dL) | 4.4 ± 0.3 |
Sodium (mEq/L) | 142 ± 2 |
Potassium (mEq/L) | 4.3 ± 0.3 |
Chloride (mEq/L) | 105 ± 3 |
International normalized ratio | 1.00 ± 0.06 |
Activated partial thrombin time (s) | 27.7 ± 3.1 |
Intraoperative findings | |
Total surgery duration (min) | 171 ± 29 |
Intrathecal morphine block | 116 (31.7%) |
Average vital signs | |
Systolic blood pressure (mmHg) | 123 ± 13 |
Diastolic blood pressure (mmHg) | 77 ± 9 |
Heart rate (beats/min) | 73 ± 10 |
Body temperature (°C) | 36.4 ± 0.5 |
Hourly fluid infusion (mL/kg/h) | 5.1 ± 2.9 |
Hourly urine output (mL/kg/h) | 1.3 ± 1.1 |
Total blood loss (mL) | 95 ± 98 |
Postoperative findings | |
Total days of hospitalization | 4 ± 1 |
Estimated glomerular filtration rate on POD 1 | |
≥ 60 mL/min/1.73 m2 | 126 (34.4%) |
< 60 mL/min/1.73 m2 | 240 (65.6%) |
Estimated glomerular filtration rate on POD 7 | |
≥ 60 mL/min/1.73 m2 | 125 (34.2%) |
< 60 mL/min/1.73 m2 | 241 (65.8%) |
Comparison of pre- and intraoperative findings between living donors with eGFR ≥60 mL/min/1.73 m2 and those with eGFR < 60 mL/min/1.73 m2 on POD 1
Group | eGFR ≥ 60 mL/min/1.73 m2 on POD 1 | eGFR < 60 mL/min/1.73 m2 on POD 1 | p |
---|---|---|---|
n | 126 | 240 | |
Preoperative findings | |||
Male sex: n (%) | 39 (31.0%) | 115 (47.9%) | 0.002 |
Age (years) | 43 (29–53) | 51 (42–58) | < 0.001 |
Body mass index ≥25 kg/m2 | 34 (27.0%) | 88 (36.7%) | 0.062 |
Hypertension n (%) | 2 (1.6%) | 19 (7.9%) | 0.013 |
Remnant kidney volume (mL) | 173.0 (149.5–203.5) | 170.0 (148.5–200.0) | 0.717 |
eGFR | |||
≥ 90 mL/min/1.73 m2 | 64 (50.8%) | 133 (55.4%) | 0.399 |
89–60 mL/min/1.73 m2 | 62 (49.2%) | 107 (44.6%) | |
Laboratory variables | |||
White blood cell count (× 109/L) | 5.9 (5.0–7.0) | 5.8 (5.1–6.7) | 0.796 |
Hemoglobin (g/dL) | 13.7 (12.8–14.9) | 14.1 (13.3–15.3) | 0.004 |
Platelet count (× 109/L) | 246.5 (216.8–304.8) | 243.0 (213.3–280.8) | 0.115 |
Glucose (mg/dL) | 95 (90–101) | 97 (92–103) | 0.109 |
Albumin (g/dL) | 4.5 (4.3–4.6) | 4.5 (4.3–4.6) | 0.724 |
Sodium (mEq/L) | 141 (140–142) | 142 (141–143) | 0.001 |
Potassium (mEq/L) | 4.3 (4.1–4.4) | 4.3 (4.1–4.5) | 0.519 |
Chloride (mEq/L) | 104 (103–106) | 105 (104–106) | 0.125 |
International normalized ratio | 1.01 (0.97–1.04) | 0.99 (0.96–1.03) | 0.010 |
aPTT (s) | 27.4 (26.0–29.1) | 27.1 (25.6–28.5) | 0.156 |
Intraoperative findings | |||
Intrathecal morphine block | 63 (50.0%) | 53 (22.1%) | < 0.001 |
Total surgery duration (min) | 170 (155–190) | 170 (147–190) | 0.214 |
Average vital signs | |||
Systolic blood pressure (mmHg) | 120 (112–130) | 120 (115–130) | 0.596 |
Diastolic blood pressure (mmHg) | 80 (70–80) | 80 (70–80) | 0.298 |
Heart rate (beats/min) | 76 (70–82) | 72 (64–80) | < 0.001 |
Body temperature (°C) | 36.5 (36.3–36.8) | 36.4 (36.1–36.6) | < 0.001 |
Hourly fluid infusion (mL/kg/h) | 4.7 (3.3–7.0) | 4.4 (2.9–6.2) | 0.144 |
Hourly urine output (mL/kg/h) | 1.0 (0.7–1.7) | 0.9 (0.6–1.6) | 0.084 |
Total blood loss (mL) | 50 (50–100) | 70 (50–100) | 0.353 |
Association of pre- and intraoperative findings with eGFR < 60 mL/min/1.73 m2 on POD 1
Univariable logistic regression analysis | Multivariable logistic regression analysis | |||||||
---|---|---|---|---|---|---|---|---|
ß | Odds ratio | 95% CI | p | ß | Odds ratio | 95% CI | p | |
Preoperative findings | ||||||||
Female sex | −0.719 | 0.487 | 0.309–0.768 | 0.002 | − 0.987 | 0.373 | 0.214–0.65 | 0.001 |
Age (years) | 0.055 | 1.057 | 1.037–1.077 | < 0.001 | 0.071 | 1.074 | 1.05–1.098 | < 0.001 |
Body mass index ≥25 kg/m2 | − 0.449 | 0.638 | 0.398–1.024 | 0.063 | ||||
Hypertension | 1.673 | 5.330 | 1.221–23.265 | 0.026 | ||||
Remnant kidney volume (mL) | −0.001 | 0.999 | 0.993–1.005 | 0.725 | ||||
eGFR ≥90 mL/min/1.73 m2 | − 0.186 | 0.83 | 0.539–1.279 | 0.399 | ||||
Laboratory variables | ||||||||
White blood cell count (× 109/L) | − 0.041 | 0.960 | 0.844–1.092 | 0.535 | ||||
Hemoglobin (g/dL) | 0.219 | 1.245 | 1.072–1.447 | 0.004 | ||||
Platelet count (× 109/L) | −0.005 | 0.995 | 0.991–0.999 | 0.007 | ||||
Glucose (mg/dL) | 0.012 | 1.012 | 0.991–1.035 | 0.267 | ||||
Albumin (g/dL) | −0.286 | 0.751 | 0.316–1.786 | 0.518 | ||||
Sodium (mEq/L) | 0.205 | 1.227 | 1.076–1.399 | 0.002 | ||||
Potassium (mEq/L) | 0.396 | 1.485 | 0.689–3.202 | 0.313 | ||||
Chloride (mEq/L) | 0.079 | 1.083 | 0.965–1.215 | 0.177 | ||||
International normalized ratio | −3.633 | 0.026 | 0.001–1.172 | 0.06 | ||||
Activated partial thrombin time (s) | −0.054 | 0.948 | 0.885–1.015 | 0.127 | ||||
Intraoperative findings | ||||||||
Time effecta | 0.000 | 1.000 | 0.997–1.002 | 0.639 | ||||
Analgesic intervention | ||||||||
No ITMB | Reference | Reference | ||||||
ITMB | −1.261 | 0.283 | 0.178–0.451 | < 0.001 | −1.341 | 0.262 | 0.154–0.445 | < 0.001 |
Total surgery duration (min) | −0.004 | 0.996 | 0.989–1.003 | 0.280 | ||||
Average vital signs | ||||||||
Systolic blood pressure (mmHg) | 0.006 | 1.006 | 0.990–1.024 | 0.458 | ||||
Diastolic blood pressure (mmHg) | 0.018 | 1.018 | 0.994–1.043 | 0.135 | ||||
Heart rate (beats/min) | −0.041 | 0.960 | 0.939–0.981 | < 0.001 | ||||
Body temperature (°C) | −0.765 | 0.466 | 0.257–0.843 | 0.012 | ||||
Hourly fluid infusion (mL/kg/h) | −0.065 | 0.937 | 0.871–1.009 | 0.084 | − 0.105 | 0.9 | 0.826–0.981 | 0.017 |
Hourly urine output (mL/kg/h) | − 0.147 | 0.864 | 0.714–1.045 | 0.131 | ||||
Total blood loss (mL) | 0.000 | 1.000 | 0.998–1.003 | 0.795 |
Comparison of pre- and intraoperative findings between the non-ITMB and ITMB groups in PS-matching analysis
Before propensity score matched analysis | After propensity score matched analysis | |||||||
---|---|---|---|---|---|---|---|---|
Group | non-ITMB | ITMB | p | SD | non-ITMB | ITMB | p | SD |
n | 250 | 116 | 106 | 106 | ||||
Preoperative findings | ||||||||
Female sex (%) | 133 (53.2%) | 79 (68.1%) | 0.007 | 0.318 | 65 (61.3%) | 70 (66.0%) | 0.475 | 0.101 |
Age (years) | 50 (38–57) | 48 (37–55) | 0.258 | − 0.114 | 48 (36–56) | 48 (37–56) | 0.835 | 0.039 |
Body mass index ≥25 kg/m2 | 88 (35.2%) | 34 (29.3%) | 0.266 | 0.129 | 32 (30.2%) | 33 (31.1%) | 0.882 | −0.021 |
Hypertension | 18 (7.2%) | 3 (2.6%) | 0.077 | −0.289 | 2 (1.9%) | 3 (2.8%) | > 0.999 | 0.059 |
Remnant kidney volume (mL) | 170.0 (148.0–202.0) | 170.0 (150.0–200.0) | 0.938 | −0.025 | 170.0 (148.0–202.0) | 170.0 (150.0–200.0) | 0.721 | 0.014 |
eGFR (89–60 mL/min/1.73 m2) | 136 (54.4%) | 33 (28.4%) | < 0.001 | −0.573 | 41 (38.7%) | 33 (31.1%) | 0.249 | −0.167 |
Laboratory variables | ||||||||
WBC count (× 109/L) | 5.9 (5.0–6.9) | 5.8 (5.1–6.8) | 0.836 | 0.009 | 5.8 (5.0–6.8) | 5.9 (5.0–6.8) | 0.881 | 0.012 |
Hemoglobin (g/dL) | 14.1 (13.3–15.3) | 13.7 (12.7–14.9) | 0.003 | −0.323 | 14.0 (13.2–15.2) | 13.8 (12.8–14.9) | 0.215 | −0.184 |
Platelet count (× 109/L) | 243.0 (211.8–281.8) | 248.0 (220.5–294.0) | 0.216 | 0.149 | 242.5 (215.0–291.3) | 243.5 (218.0–294.0) | 0.937 | −0.029 |
Glucose (mg/dL) | 96 (91–103) | 97 (91–103) | 0.655 | 0.083 | 97 (92–103) | 97 (91–102) | 0.703 | −0.055 |
Albumin (g/dL) | 4.5 (4.2–4.6) | 4.5 (4.3–4.7) | 0.067 | 0.245 | 4.5 (4.3–4.7) | 4.5 (4.3–4.7) | 0.641 | −0.045 |
Sodium (mEq/L) | 142 (141–143) | 141 (141–143) | 0.024 | −0.219 | 142 (141–143) | 142 (141–143) | 0.766 | −0.028 |
Potassium (mEq/L) | 4.3 (4.1–4.4) | 4.3 (4.1–4.5) | 0.942 | −0.016 | 4.3 (4.1–4.4) | 4.3 (4.1–4.5) | 0.57 | 0.067 |
Chloride (mEq/L) | 105 (104–106) | 104 (103–106) | 0.090 | −0.243 | 104 (103–106) | 105 (103–106) | 0.713 | −0.133 |
INR | 1.00 (0.96–1.03) | 1.00 (0.96–1.04) | 0.350 | 0.096 | 1.00 (0.97–1.03) | 1.00 (0.96–1.04) | 0.561 | −0.065 |
aPTT (s) | 27.5 (25.6–29.1) | 27.0 (25.8–28.2) | 0.118 | −0.271 | 27.0 (25.6–28.5) | 26.9 (25.8–28.3) | 0.686 | −0.124 |
Intraoperative findings | ||||||||
Surgery duration (min) | 175 (160–190) | 155 (140–180) | < 0.001 | −0.531 | 165 (150–185) | 160 (140–185) | 0.108 | −0.188 |
Average of vital signs | ||||||||
SBP (mmHg) | 120 (116–130) | 120 (112–130) | 0.727 | −0.056 | 120 (120–130) | 121 (112–131) | 0.884 | 0.029 |
DBP (mmHg) | 80 (70–80) | 80 (72–88) | 0.002 | 0.339 | 80 (71–80) | 80 (74–87) | 0.137 | 0.158 |
Heart rate (beats/min) | 74 (67–80) | 72 (63–80) | 0.266 | −0.086 | 74 (64–80) | 72 (63–80) | 0.455 | −0.06 |
Body temperature (°C) | 36.5 (36.3–36.7) | 36.3 (36.1–36.6) | 0.002 | −0.275 | 36.5 (36.2–36.7) | 36.4 (36.1–36.6) | 0.311 | −0.091 |
Hourly fluid infusion (mL/kg/h) | 4.86 (3.35–7.03) | 3.80 (2.56–5.67) | < 0.001 | −0.348 | 4.79 (2.84–6.19) | 3.82 (2.62–5.85) | 0.215 | −0.079 |
Hourly urine output (mL/kg/h) | 0.98 (0.67–1.71) | 0.96 (0.63–1.52) | 0.261 | −0.284 | 0.86 (0.65–1.39) | 0.96 (0.62–1.51) | 0.655 | 0.039 |
Total blood loss (mL) | 95 (50–100) | 50 (50–100) | 0.017 | −0.451 | 50 (50–100) | 50 (50–100) | 0.48 | −0.068 |
Comparison of remnant kidney function according to eGFR status on PODs 1 and 7 between PS-matched non-ITMB and ITMB groups
After adjustment for PS, ITMB was significantly associated with eGFR < 60 mL/min/1.73 m2 on POD 1
ß | Odds ratio | 95% CI | p | |
---|---|---|---|---|
PS-matched living donors (n = 212) | ||||
ITMB adjusted for PS | −1.358 | 0.257 | 0.14–0.474 | < 0.001 |