The Prevalence of Systemic Venous Congestion Post Kidney Transplant Detected by Point of Care Ultrasound (POCUS)

TL;DR

This study found that nearly half of kidney transplant patients showed signs of venous congestion in the first week post-transplant, but severe cases were rare.

Contribution

The study is the first to describe the prevalence of systemic venous congestion in kidney transplant recipients using POCUS.

Findings

Venous congestion was detected in 53% of patients, with 13.3% having moderate to severe congestion.

Pulmonary congestion was more common, affecting 70% of patients.

Body weight and physical exams were unreliable for assessing fluid status.

Abstract

Systemic venous congestion is a known cause of acute kidney injury (AKI), but its presence in kidney transplant patients has not been previously described in the literature. The objective of this study was to determine the prevalence of systemic venous congestion in recent kidney transplant recipients. We conducted a prospective, longitudinal, descriptive study including 30 adult patients during the first week post-renal transplant at the Instituto de Trasplante y Alta Complejidad in Buenos Aires, Argentina. Venous congestion was detected in 53% of patients (16/30), but only 13.3% (4/30) presented moderate to severe congestion. Pulmonary congestion was more frequent: 70% (21/30) of the patients presented some degree of pulmonary congestion, and 30% (9/30) had moderate or severe congestion. In the venous congestion group, 75% of patients developed delayed graft function (DGF) compared to 57% in the non-congestion group, although this difference was not statistically significant (p<0.3). Body weight and physical examination—two commonly used methods to guide decisions on dialysis initiation and fluid management—were found to be unreliable for assessing the true volume status. In conclusion, venous congestion was observed during the first week following renal transplantation; however, moderate to severe congestion was uncommon, affecting only 13.3% of patients. While DGF was more frequently observed in patients with congestion, a statistically significant association could not be established. Further studies with larger sample sizes are needed to better evaluate this potential relationship.

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