Association of Intraoperative Hypotension With Delayed Graft Function Following Kidney Transplant: A Single Centre Retrospective Cohort Study
Bibliographic record
Abstract
BACKGROUND: Intraoperative hypotension is associated with acute kidney injury after surgery. However, the definition (duration and magnitude) of hypotension during kidney transplantation (KT) surgery on early graft function remains unclear. METHODS: We conducted a retrospective cohort study of KT recipients from December 1, 2009, to December 31, 2019. Exposure to intraoperative hypotension was characterized as the duration (minutes) of mean arterial pressure (MAP) <55, <65, <75, and <85 mmHg. Our co-primary outcomes were DGF-creatinine reduction ratio (DGF-CRR, <30% creatinine reduction, postoperative days 1 and 2), and DGF-dialysis (DGF-D, required dialysis within the week of KT for deceased donor recipients). Logistic regression models were fitted to assess this relationship between MAP and DGF. RESULTS: We included 1602 KT (939 deceased donors, 663 living donors) and 23 were excluded. DGF-CRR occurred in 33% of patients. DGF-CRR was associated with MAP < 65 (>5 min: OR 1.77, 95% confidence interval [CI]: 1.39-2.30; 6-10 min: OR 1.67, 95% CI: 0.97-2.86; 11-20 min: OR 2.18, 95% CI: 1.31-3.63) in unadjusted and <55 mmHg (5 min: OR 1.85, 95% CI: 1.47-2.32; 5-10 min: OR 2.41, 95% CI: 1.65-3.53; 11-20 min: OR 2.36, 95% CI: 1.60, 3.48) in adjusted models. There was also a signal for increased risk of DGF-CRR at MAP < 75 (>5 min: OR 1.69, 95% CI: 1.02-2.80). DGF-D (incidence 35%) in deceased donor KT was not associated with hypotension. CONCLUSIONS: We found an association between intraoperative hypotension and DGF-CRR at a threshold MAP of 55 mmHg, with a consistent signal toward increased risk at both 65 and 75 mmHg, as indicated by unadjusted models.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".