Introduction: Kidney and pancreas transplant recipients undergo significant fluid shifts in the post-operative period leading to significant lower limb edema. Intermittent compression (IPC) devices are used to reverse the edema, however many factors may limit the use of IPC units. The Geko Plus device is an internally powered calf neuro muscular stimulator, which has previously been shown to have beneficial effects in improving blood flow. Its role in transplantation has not previously been assessed.

Purpose: To prospectively evaluate the effects of IPC and Geko devices on lower limb edema in reno/pancreatic transplant patients.

Methods: We performed a prospective, randomized, controlled study where 25 patients were randomly assigned to wear IPC (Group1, n= 14) or the Geko device (Group 2, n=11) post-operatively until day 6 after surgery. We measured patient weight and lower leg and thigh circumferences daily. Ultrasound Doppler of the allograft and of the lower limbs was carried out on post-operative days 1 and 5 to assess venous flow velocity in the femoral vein. Also, we monitored total urine output, serum creatinine levels.

Results: Median age of the recipients was 50( 24-72 )years and 72% were male. 22 patients underwent kidney transplantation and 3 underwent kidney and pancreas transplantation. There were no differences in the BMI of the recipients in either group. Donor type were as follows: Group 1:3DCD,6 NDD,5 LD and Group 2:4 DCD,5 NDD,2 LD. We observed a significant increase in calf circumference following transplantation in Group 1 by 7.2% (2.3 +/- 2cm) compared to Group 2 which showed no change from baseline (0.13%, 0.05 +/- 0.95 cm, p=<0.0001). Thigh circumference also followed a similar trend with only Group 1 showing a significant increase (5.5%,2.4 +/- 2cm) from baseline compared to Group 2 (p=<0.001). Doppler ultrasound showed a remarkable increase in mean flow velocity in the Geko Plus patients of 19cm/s whereas the IPC patients showed lower velocities 11cm/s (p=<0.0005). There was no significant difference between groups in serum creatinine, weight change, urine output, and resistive index of the allograft. There were no complications in either group.

Conclusion: We report, for the first time, that the use of the Geko Plus device in the immediate post-operative period leads to an improvement in lower limb edema and in venous flow in reno/pancreatic transplant recipients compared to standard IPC.

CITATION INFORMATION: Alharbi B, Ali O, Saha M, May M, Luke P, Sener A. Neuromuscular Stimulation Leads to Improved Lower Limb Edema and Blood Flow Compared to Standard Compression Devices Following Kidney and Pancreatic Transplantation. Am J Transplant. 2016;16 (suppl 3).

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