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Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation‐based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision‐making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single‐center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Individuals with moderate-to-severe reduced renal function have greater risk of gastrointestinal bleeding than those with normal renal function. We conducted a retrospective matched cohort study to assess whether living kidney donors share a similar risk. We reviewed pre-donation charts for living kidney donations from 1992 to 2009 in Ontario, Canada, and linked this information to healthcare databases. We selected healthy non-donors from the general population and matched ten non-donors to every donor. Of the 2009 donors and 20 090 matched non-donors, none had evidence of gastrointestinal bleeding prior to cohort entry. The cohort was followed for a median of 8.4 yr (maximum 19.7 yr; loss to follow-up <7%). There was no significant difference in the rate of hospitalization with gastrointestinal bleeding in donors compared to non-donors (18.5 vs. 14.9 events per 10 000 person-years; rate ratio 1.24; 95% confidence interval [CI] 0.85-1.81). Similar results were obtained when we assessed the time to first hospitalization with gastrointestinal bleeding (hazard ratio 1.25, 95% CI 0.87-1.79). In conclusion, we found living kidney donation was not associated with a higher risk of hospitalization with gastrointestinal bleeding. These results are reassuring for the safety of the practice. [ABSTRACT FROM AUTHOR]