Muscle-Pump Activator Cuts Hospital Time, Edema After Kidney Transplantation

By Rob Goodier

June 13, 2019

NEW YORK (Reuters Health) - Switching standard compression stockings for muscle-pump activators (MPAs) on a kidney-transplantation patient's legs cuts hospitalization time and improves short-term outcomes, a new randomized trial suggests.

"We are seeing a significant increase in urine output, decrease in edema and increase in patient satisfaction compared to just wearing the compression stocking, as well as greater blood flow to the kidney," Dr. Alp Sener of Western University in London, Canada, told Reuters Health by email.

In the trial, presented June 3 at the American Transplant Congress in Boston, Dr. Sener and colleagues randomized 221 patients who had undergone kidney or simultaneous pancreas and kidney transplantation to use the MPA or traditional compression stockings with intermittent pneumatic compression devices for one week.

"Normally, when patients have any operation, including transplant, they wear compression stockings, and boots," said Dr. Sener. "Wearing those things can be hot, patients don't like them. They can be irritating, especially for patients who are obese. (With the MPA), they don't wear any of that. In this case, it's a sticker the size of a pen, an inch thick, has a power generator and stimulates the leg equivalent to walking several miles per day."

The MPA group stayed in the hospital 8.15 days compared to 9.36 days in the control group (P=0.038). Mid-calf leg circumference and patient weight, both markers of fluid retention, were significantly lower in the MPA group.

Patients with the MPA had more urine output, improved blood flow to the transplanted kidney and a 60% reduction in wound infection rates at 30-days follow-up. They also recorded significantly more steps on a pedometer.

The MPA did not appear to significantly affect measures of renal function, however, including the rate of delayed graft function, dialysis and serum creatinine.

The devices are a low-cost and easy change from the current approach that appear to have a measurable impact, Dr. Sener said.

"Based on our experience in our center it has become the standard of care. I think that probably the greatest benefit is going to be in deceased donor kidneys, donation after cardiac death and neurologic death," he said.

Data from one-year follow-up are pending, Dr. Sener noted, adding, "Greater urine output after transplant does portend better outcomes."

"This study is an example of how a creative adjustment to patient care can result in better early outcomes," Dr. Ronald Gill, a professor of surgery at the University of Colorado Anschutz Medical Campus in Aurora, who was not involved in the study, told Reuters Health by email.

SOURCE: http://bit.ly/2X74xpZ

American Transplant Congress 2019.

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