Kidney Week

Abstract: TH-PO790

Venous Excess Ultrasound (VExUS) and Lung Ultrasound (LUS) in Post-transplant (PosKTx) Volume Assessment (VA): Is There a Place for Them?

Session Information

• Transplantation: Clinical - 2
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Sosa Barrios, Haridian, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Haridian Sosa Barrios, MD

• Minguez, Irene, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Irene Minguez

• Burguera, Victor, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Victor Burguera, MD

• Galeano, Cristina, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Cristina Galeano

• Elias, Sandra, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Sandra Elias, MD

• Roncal Redin, Miriam, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Miriam Roncal Redin

• Sánchez, Jorge, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Jorge Sánchez, MD

• Moreno Garcia, Raquel, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Raquel Moreno Garcia

• Fernandez-Lucas, Milagros, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Milagros Fernandez-Lucas, MD, PhD

• Rivera Gorrin, Maite, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Maite Rivera Gorrin, DrMed, PhD

Group or Team Name

• Grupo de Nefrología Diagnóstica e Intervencionista de la Sociedad Española de Nefrología (GNDI).

Background

VA in the posKTx period reduces morbidity and mortality, saving resources.LUS, VExUS and bioimpedance (BIA) are volume evaluation methods on the rise.

Methods

Prospective single-center study (4-12/23):31 pts (Group1) VA days+1 and +7 (LUS, VExUS, BIA and physical examination (PE) vs 40 previous KTx (Group 2) assessed clinically.

Results

Characteristics in table 1. No differences at baseline or evolution (delayed function, RRT, hospitalization or cardiovascular events (CVE) nor weight gain day+1, although there were 6 acute pulmonary edema in group 2 (post-KTx) and only 2 post-discharge in group 1.
BIA not correlated with PE (p 0.022). VExUS score and BIA did not correlate.
BNP and Ca125: 88% with CVE had elevated BNP and 22% high Ca125. Of those requiring HDx, 85.7% had elevated BNP and 14.2% risen Ca125.
VExUS score:
Day+1 VExUS1 (3): 50% elevated BNP but normal Ca125. VExUS 2 (1) elevated Ca125 + BNP. VExUS 3 none.
Day+7 VExUS1 (4): 75% elevated BNP and 25% elevated Ca125.
VExUS+LUS detected hypervolemia with normal PE (3 mild edema and VExUS 1-2, 9 pathological LUS without clinical edema or only mild), although not significantly.
VExUS modified treatment in 77.6% day+1 and 30% day+7: day 1--> No 7 (22.6%), reducing iv fluids 71%; reducing iv fluids+diuretics 1, lower limb edema due to lymphocele 1.Day 7--> No 19 (70.1%), reducing iv fluids 2, stopping iv fluids 2, HDx 1, other findings 3 (2 retroperitoneal bleedings and 1 perirrenal haematoma).

Conclusion

LUS+VExUS outperformed PE for accurate management of posKTx volume, detecting hypervolemia early and modifying the therapeutic attitude up to almost 78% of cases. BIA correlated poorly with volume status in these patients.