Daily use of a muscle pump activator device reduces duration of hospitalization and improves early graft outcomes post-kidney transplantation: A randomized controlled trial

Abstract

Introduction: Kidney and simultaneous pancreas-kidney (SPK) transplant recipients can have prolonged postoperative hospitalization due to edema. Thrombo-embolic-deterrent (TED) stockings with intermittent pneumatic compression devices (TED+IPC) have been used to improve venous return during the perioperative period. The objective of this trial was to evaluate the effects of TED+IPC vs. muscle pump activator (MPA) devices on factors that could reduce postoperative complications and duration of hospitalization.

Methods: In this single-center, prospective, randomized, controlled trial, 221 kidney and SPK transplant recipients were randomized to either wearing TED+IPC or MPA for six days postoperatively. Groups were compared with respect to postoperative urine output, lower limb edema, weight, days in hospital, mobility, serum creatinine, delayed graft function, need for dialysis, and lower extremity blood flow.

Results: Patients in the MPA group had significantly higher urine output and less increase in mid-calf leg circumference and weight gain compared to the TED+IPC group (p=0.003, p=0.001, and p=0.003, respectively). The MPA group also experienced shorter hospitalization (p=0.038), higher femoral vein velocity (p=0.001), and took more steps (p=0.009). Incidence of delayed graft function (p=0.72) and number of dialysis runs (p=0.39) was not different between study groups. Subgroup analysis of primary endpoints in donation after cardiac death recipients and SPK recipients did not yield any significance between the study arms.

Conclusions: Postoperative use of the MPA device increases urine output, decreases leg edema, minimizes weight gain, and decreases duration of hospitalization after kidney transplantation. A larger and longer-term trial is needed to evaluate the impact on graft function.

Fig. 1

The The geko™ (Firstkind Ltd, U.K.) device worn as a band over the legs bilaterally, just inferior to the fibular heads.

Fig. 2

Mean change in calf circumference between postoperative day 1 and 6. The MPA group had a significantly lower increase in calf circumference compared to the TED+IPC group (2.5±1.5 cm vs. 3.6±1.5 cm, p=0.001). IPC: intermittent pneumatic compression; MPA: muscle pump activator; TED: thrombo-embolic-deterrent.

Fig. 3

Mean change in patient weight between postoperative day 1 and 6. The MPA group had a significantly lower increase in calf circumference compared to the TED+IPC group (4.06±2.3 kg vs. 5.18±2.8 kg, p=0.003). IPC: intermittent pneumatic compression; MPA: muscle pump activator; TED: thrombo-embolic-deterrent.

Fig. 4

Mean length of hospitalization. Participants in the MPA group had a significantly shorter hospital stay compared to the TED+IPC group (9.36±5.0 days vs. 8.15±3.5 days, p=0.038). No difference in length of hospitalization between the study groups was seen in SPK patients. IPC: intermittent pneumatic compression; MPA: muscle pump activator; TED: thrombo-embolic-deterrent.

Fig. 5

Average number of steps taken on postoperative day 1 to 6. The MPA group taken a significantly higher number of steps compared to the TED+IPC group (1231±189 steps vs 1099±249 steps, p=0.009). IPC: intermittent pneumatic compression; MPA: muscle pump activator; TED: thrombo-embolic-deterrent.