J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 7, July 2026, pages 456-464

Pulse Index Continuous Cardiac Output-Guided Hemodynamic Therapy in Living Donor Kidney Transplantation: A Prospective Cohort Study

↓ **Table 1.** Baseline Patient Characteristics
Characteristic	Group C (n = 40)	Group P (n = 40)	P value
Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate; categorical variables were compared using the Fisher’s exact test when expected counts were sparse. BMI: body mass index; ASA: American Society of Anesthesiologists; IQR: interquartile range; SD: standard deviation.
Donor age (years), median (IQR)	54.5 (47–62)	53.0 (46–61)	0.725
Recipient age (years), mean ± SD	36.6 ± 7.7	36.4 ± 9.3	0.890
Male sex, n (%)	22 (55.0)	23 (57.5)	0.820
Dry weight (kg), mean ± SD	55.0 ± 9.8	54.5 ± 8.4	0.800
BMI (kg/m²), mean ± SD	20.9 ± 2.8	20.9 ± 2.2	0.970
Hypertension, n (%)	40 (100)	40 (100)	1.00
Diabetes, n (%)	0 (00)	0 (00)	1.00
ASA III/IV, n (%)	38 (95.0)/2 (5.0)	37 (92.5)/3 (7.5)	0.650
Cold ischemia time (min), mean ± SD	108.2 ± 20.2	120.9 ± 23.4	0.011
Operative time (min), mean ± SD	258.5 ± 46.3	249.4 ± 55.0	0.426

↓ Table 1. Baseline Patient Characteristics

Characteristic

Group C (n = 40)

Group P (n = 40)

P value

Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate; categorical variables were compared using the Fisher’s exact test when expected counts were sparse. BMI: body mass index; ASA: American Society of Anesthesiologists; IQR: interquartile range; SD: standard deviation.

Donor age (years), median (IQR)

54.5 (47–62)

53.0 (46–61)

0.725

Recipient age (years), mean ± SD

36.6 ± 7.7

36.4 ± 9.3

0.890

Male sex, n (%)

22 (55.0)

23 (57.5)

0.820

Dry weight (kg), mean ± SD

55.0 ± 9.8

54.5 ± 8.4

0.800

BMI (kg/m²), mean ± SD

20.9 ± 2.8

20.9 ± 2.2

0.970

Hypertension, n (%)

40 (100)

1.00

Diabetes, n (%)

0 (00)

1.00

ASA III/IV, n (%)

38 (95.0)/2 (5.0)

37 (92.5)/3 (7.5)

0.650

Cold ischemia time (min), mean ± SD

108.2 ± 20.2

120.9 ± 23.4

0.011

Operative time (min), mean ± SD

258.5 ± 46.3

249.4 ± 55.0

0.426

↓ **Table 2.** Graft Function
Variable	Group C (n = 40)	Group P (n = 40)	P value
Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate. IQR: interquartile range; SD: standard deviation; DGF: delayed graft function; post-op: postoperative.
Serum creatinine pre-op (mg/dL), mean ± SD	8.6 ± 2.4	8.9 ± 2.6	0.600
Serum creatinine day 1 (mg/dL), median (IQR)	4.6 (3.8–5.3)	4.9 (3.1–6.2)	0.470
Serum creatinine day 3 (mg/dL), median (IQR)	1.6 (1.4–1.9)	1.3 (0.8–1.8)	0.036
Serum creatinine day 7 (mg/dL), median (IQR)	1.3 (1.1–2.1)	1.1 (0.7–1.4)	0.16
Urine output Hour 1 post-op (mL), mean ± SD	1,010 ± 315	1,235 ± 162	< 0.001
Urine output day 1 (mL), mean ± SD	8,632 ± 2,477	9,023 ± 2,288	0.410
DGF (dialysis within 7 days), n (%)	0 (0)	0 (0)	1.000

↓ Table 2. Graft Function

Variable

Group C (n = 40)

Group P (n = 40)

P value

Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate. IQR: interquartile range; SD: standard deviation; DGF: delayed graft function; post-op: postoperative.

Serum creatinine pre-op (mg/dL), mean ± SD

8.6 ± 2.4

8.9 ± 2.6

0.600

Serum creatinine day 1 (mg/dL), median (IQR)

4.6 (3.8–5.3)

4.9 (3.1–6.2)

0.470

Serum creatinine day 3 (mg/dL), median (IQR)

1.6 (1.4–1.9)

1.3 (0.8–1.8)

0.036

Serum creatinine day 7 (mg/dL), median (IQR)

1.3 (1.1–2.1)

1.1 (0.7–1.4)

0.16

Urine output Hour 1 post-op (mL), mean ± SD

1,010 ± 315

1,235 ± 162

< 0.001

Urine output day 1 (mL), mean ± SD

8,632 ± 2,477

9,023 ± 2,288

0.410

DGF (dialysis within 7 days), n (%)

0 (0)

1.000

↓ **Table 3.** Intraoperative Hemodynamics
Variable	Group C (n = 40)	Group P (n = 40)	P value
Values are mean ± SD unless otherwise stated. Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate; categorical variables were compared using the Fisher’s exact test when expected counts were sparse. MAP: mean arterial pressure; CVP: central venous pressure.
MAP T0, before induction (mm Hg)	105.1 ± 15.5	103.2 ± 16.5	0.580
MAP T1, 30 min post-induction (mm Hg)	95.9 ± 14.7	94.0 ± 16.7	0.570
MAP T2, 30 min pre-reperfusion (mm Hg)	95.4 ± 15.9	94.3 ± 16.7	0.580
MAP T3, post-reperfusion (mm Hg)	102.0 ± 11.8	98.5 ± 11.0	0.140
MAP T4, End of surgery (mm Hg)	104.0 ± 10.9	102.2 ± 13.6	0.470
CVP T1 (cm H₂O)	9.8 ± 2.8	9.2 ± 2.7	0.350
CVP T2 (cm H₂O)	12.7 ± 3.8	14.1 ± 6.4	0.260
CVP T3 (cm H₂O)	13.1 ± 3.1	14.4 ± 4.4	0.140
CVP T4 (cm H₂O)	12.7 ± 3.0	13.0 ± 4.4	0.780
Vasopressor use, n (%)	11 (27.5)	5 (12.5)	0.161

↓ Table 3. Intraoperative Hemodynamics

Variable

Group C (n = 40)

Group P (n = 40)

P value

Values are mean ± SD unless otherwise stated. Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate; categorical variables were compared using the Fisher’s exact test when expected counts were sparse. MAP: mean arterial pressure; CVP: central venous pressure.

MAP T0, before induction (mm Hg)

105.1 ± 15.5

103.2 ± 16.5

0.580

MAP T1, 30 min post-induction (mm Hg)

95.9 ± 14.7

94.0 ± 16.7

0.570

MAP T2, 30 min pre-reperfusion (mm Hg)

95.4 ± 15.9

94.3 ± 16.7

0.580

MAP T3, post-reperfusion (mm Hg)

102.0 ± 11.8

98.5 ± 11.0

0.140

MAP T4, End of surgery (mm Hg)

104.0 ± 10.9

102.2 ± 13.6

0.470

CVP T1 (cm H₂O)

9.8 ± 2.8

9.2 ± 2.7

0.350

CVP T2 (cm H₂O)

12.7 ± 3.8

14.1 ± 6.4

0.260

CVP T3 (cm H₂O)

13.1 ± 3.1

14.4 ± 4.4

0.140

CVP T4 (cm H₂O)

12.7 ± 3.0

13.0 ± 4.4

0.780

Vasopressor use, n (%)

11 (27.5)

5 (12.5)

0.161

↓ **Table 4.** Intraoperative Fluid Volumes
Variable	Group C (n = 40)	Group P (n = 40)	P value
Values are mean ± SD. Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate.
Fluid pre-reperfusion (mL), mean ± SD	2,133.0 ± 436.5	1,871.7 ± 387.6	0.006
Fluid post-reperfusion (mL), mean ± SD	964,00 ± 290,15	785,40 ± 343,73	0.014
Total intraoperative fluid (mL), mean ± SD	3,097 ± 555	2,656 ± 480	0.001

↓ Table 4. Intraoperative Fluid Volumes

Variable

Group C (n = 40)

Group P (n = 40)

P value

Values are mean ± SD. Continuous variables were compared using the two-sample t-test or Mann–Whitney U test, as appropriate.

Fluid pre-reperfusion (mL), mean ± SD

2,133.0 ± 436.5

1,871.7 ± 387.6

0.006

Fluid post-reperfusion (mL), mean ± SD

964,00 ± 290,15

785,40 ± 343,73

0.014

Total intraoperative fluid (mL), mean ± SD

3,097 ± 555

2,656 ± 480

0.001

↓ **Table 5.** PiCCO-Derived Parameters (Group P, N = 40)
Timepoint	T1, 30 min post-induction	T2, 30 min pre-reperfusion	T3, post-reperfusion	T4, end of surgery
Reference range EVLWI < 10 mL/kg. EVLWI > 10 (mL/kg), n (%) denotes the number of patients exceeding the 10 mL/kg threshold at each timepoint. All hemodynamic values are for the PiCCO group (group P) only; no between-group statistical comparison was performed. SVV: stroke volume variation; EVLWI: extravascular lung water index; CI: cardiac index (L/min/m²); GEDVI: global end-diastolic volume index (mL/m²); SVRI: systemic vascular resistance index (dyn·s/cm⁵/m²); PiCCO: pulse index continuous cardiac output.
SVV (%), mean ± SD	7.00 ± 2.9	4.53 ± 2.3	5.81 ± 3.9	7.65 ± 5.6
EVLWI (mL/kg), mean ± SD	8.75 ± 4.1	8.60 ± 4.1	8.87 ± 4.56	9.90 ± 4.9
EVLWI > 10 (mL/kg), n (%)	11 (27.5)	8 (20)	9 (22.5)	11 (27.5)
CI (L/min/m²), mean ± SD	3.21 ± 0.69	3.54 ± 0.79	3.92 ± 0.98	4.01 ± 1.02
GEDVI (mL/m²), mean ± SD	642 ± 110.1	661 ± 114.6	672 ± 117.1	698 ± 110.2
SVRI (dyn·s/cm⁵/m²), mean ± SD	2,277 ± 694.3	1,799 ± 653.1	1,769 ± 669.6	1,810 ± 449.6

↓ Table 5. PiCCO-Derived Parameters (Group P, N = 40)

Timepoint

T1, 30 min post-induction

T2, 30 min pre-reperfusion

T3, post-reperfusion

T4, end of surgery

Reference range EVLWI < 10 mL/kg. EVLWI > 10 (mL/kg), n (%) denotes the number of patients exceeding the 10 mL/kg threshold at each timepoint. All hemodynamic values are for the PiCCO group (group P) only; no between-group statistical comparison was performed. SVV: stroke volume variation; EVLWI: extravascular lung water index; CI: cardiac index (L/min/m²); GEDVI: global end-diastolic volume index (mL/m²); SVRI: systemic vascular resistance index (dyn·s/cm⁵/m²); PiCCO: pulse index continuous cardiac output.

SVV (%), mean ± SD

7.00 ± 2.9

4.53 ± 2.3

5.81 ± 3.9

7.65 ± 5.6

EVLWI (mL/kg), mean ± SD

8.75 ± 4.1

8.60 ± 4.1

8.87 ± 4.56

9.90 ± 4.9

EVLWI > 10 (mL/kg), n (%)

11 (27.5)

8 (20)

9 (22.5)

11 (27.5)

CI (L/min/m²), mean ± SD

3.21 ± 0.69

3.54 ± 0.79

3.92 ± 0.98

4.01 ± 1.02

GEDVI (mL/m²), mean ± SD

642 ± 110.1

661 ± 114.6

672 ± 117.1

698 ± 110.2

SVRI (dyn·s/cm⁵/m²), mean ± SD

2,277 ± 694.3

1,799 ± 653.1

1,769 ± 669.6

1,810 ± 449.6

↓ **Table 6.** Postoperative Complications
Complication	Group C (n = 40)	Group P (n = 40)	P value
Variables were compared using the Fisher’s exact test.
Renal complications, n (%)	5 (12.5)	2 (5.0)	0.230
Non-renal complications, n (%)	3 (7.5)	3 (7.5)	1.000

↓ Table 6. Postoperative Complications

Complication

Group C (n = 40)

Group P (n = 40)

P value

Variables were compared using the Fisher’s exact test.

Renal complications, n (%)

5 (12.5)

2 (5.0)

0.230

Non-renal complications, n (%)

3 (7.5)

1.000