Perioperative Management of Patients Undergoing Kidney Transplantation in the United States-A National Survey.

BACKGROUND

There is no consensus on the optimal perioperative management of patients undergoing kidney transplantation, and little is known about variation in clinical practice across the United States (U.S.). We conducted a national survey to describe current perioperative management practices in patients undergoing kidney transplantation in the U.S.

METHOD: A survey was sent to all adult kidney transplant centers in the U.S. The survey encompassed questions on the perioperative care of kidney transplant recipients across six domains: fluid and electrolyte management, transfusion practices, hemodynamic management, neuromuscular blockade, robotic or laparoscopic-assisted kidney transplants, and postoperative management and analgesia.

RESULTS

We received 68 valid responses from 55 kidney transplant centers in the U.S., representing 11 663 transplants annually (41.4% of the total national volume). There was significant heterogeneity in fluid management regarding the type and volume of fluids administered. Most centers (87.2%) targeted specific intraoperative blood pressure parameters, but there was high institutional variability in those targets. Vasopressor use was also variable; phenylephrine is used as the first-line vasopressor in 26 centers (47.3%), while it is avoided by 13 centers (19.7%). Rocuronium was used by 69.1% of centers, and sugammadex reversal by 85.5%. Postoperative analgesia favored acetaminophen and IV opioids (79.6% for both agents).

CONCLUSION

This survey demonstrated significant heterogeneity in the perioperative management of kidney transplant recipients in the U.S. There is an urgent need for further research on how perioperative management strategies affect postoperative outcomes after kidney transplantation to better guide evidence-based practice.