267 Supra-Physiological Haemodynamic Optimisation Improves Short-Term Outcomes Following Simultaneous Pancreas and Kidney Transplantation: a randomised clinical trial (NCT01619904)
Monday November 16, 2015 from 11:00 to 12:30
Room 110

Hussein A Khambalia, United Kingdom

Transplant Registrar

Department of Transplantation

Manchester Royal Infirmary



Hussein Khambalia1,3, Mahesh Nirmalan2,3, David van Dellen1,3, Angela Summers1,3, Zia Moinuddin1,3, Giuseppe Giuffrida1, Insiya Susnerwala2, Simon Varley2, Yvonne Alexander3, Titus Augustine1,3.

1Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom; 2Department of Anaesthesia and Critical Care, Manchester Royal Infirmary, Manchester, United Kingdom; 3Department of Cardiovascular Research, University of Manchester, Manchester, United Kingdom

Background: Simultaneous pancreas and kidney transplantation (SPKT) is high-risk surgery, associated with significant peri-operative morbidity. Peri-operative supra-physiological optimisation (Goal-Directed Therapy, GDT) improves outcomes in other high-risk patients following major surgery. The aim of this study was to investigate the benefits of GDT in SPKT.
The primary outcome was hospital length of stay. Secondary outcomes were critical care length of stay, delayed graft function and objective markers of morbidity and recovery.
Methods: 60 SPKT recipients were randomly allocated to either GDT or Standard therapy (ST) cohorts. The GDT cohort underwent perioperative supra-physiological optimisation, guided by lithium indicator dilution, to attain an indexed oxygen delivery of greater than 600ml/min/m . The optimisation protocol was initiated at the start of surgery and continued for 6 hours post-operatively in the GDT arm. The ST cohort was managed according to current unit protocols.
Results: There were no differences in length of hospital stay between the two cohorts (18.0 days (IQR 14.0- 31.0) and 15.0 days (IQR 13.0- 22.3) in GDT and ST cohorts respectively; p= 0.162, Mann-Whitney U (MWU) test). However, the GDT cohort had significantly lower critical care unit length of stay when compared to the ST cohort (4 days (IQR 3- 5.5) and 8 days (IQR 6.0- 9.3) respectively, p<0.001, MWU test). In addition, the GDT cohort had significantly lower rates of renal delayed graft function, compared to the ST group (6.9% and 33.3% respectively, p= 0.021, Fisher’s Exact). They also had shorter time to mobilisation out of bed (2.0 days (IQR 1.0- 3.0) and 4.0 days (IQR 3.0- 6.25) respectively; p<0.001, MWU test) and shorter time to tolerating oral diet (5.0 days (IQR 4.0- 8.0) and 8.0 days (IQR 6.75- 10.0) respectively; p<0.001, MWU test).
Conclusions: This study demonstrates improved short-term outcomes following protocolised physiological optimisation following SPKT.

Departments of Transplantation, Anaesthesia and Critical care, Manchester Royal Infirmary. Catherine Fullwood, Biomedical Sciences Research centre, CMFT.

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