MPOG Retreat - October 10, 2025
Clinical Coordinating Center (UCSF)
Matthieu Legrand, MD PhD (PI)
Michael Bokoch, MD PhD (Study Director)
Niel Panchal (CRC)
Nhu Huynh (CRC)
Data Coordinating Center (Michigan/MPOG)
Sachin Kheterpal, MD, MBA (Co-PI)
Allison Janda, MD (Study Director)
Douglas Colquhoun, MD (Study Director)
Rebecca Pantis (Project Manager)
Disclosures
▪ No personal consulting, financial, or board membership with any related company
▪ I am a PI or Co-I on projects that receives or has recently received grant funding from:
- PCORI
- NIH
▪ NHLBI K23 - K23HL166685
▪ NHLBI - R01HL167790
▪ National Library of Medicine - 1R01LM01389401
▪ NIDDK - R01DK133226
▪ NIDDK - R01DK139484
▪ NIH NIGMS T32 Research Fellowship Grant – 5T32GM103730-07 (concluded)
- Haisco-USA Pharmaceuticals, Inc.
- Bio Intellisense, Inc.
THRIVE (brief) Update
Precision Feedback (brief) Update
▪ Control: Standard “one-size-fits-most”
performance feedback email
▪ Intervention: “Precisionized” message
▪ Outcomes: care quality for improvable
measures and email engagement (click-
through and dashboard login rates)
▪ 48 MPOG sites participated between the
pilot study and full trial
- Thank you!!!
▪ Data collection is complete and currently
analyzing the data
The choice of vasopressor to prevent postoperative acute kidney
injury after major non-cardiac surgery: a multicenter pragmatic
cluster cross-over randomized trial
▪ NIH-funded 10-center pragmatic cluster cross-over randomized trial
▪ Aim to recruit >18,000 patients over 120 center•months
▪ Compares phenylephrine to norepinephrine
▪ Primary outcome: Acute Kidney Injury
Thank you for engagement across MPOG!
▪ Invited sites include:
- Duke University
- Henry Ford Health System
- University of California San Francisco
- University of Maryland
- University of Michigan
- University of Texas Southwestern
- University of Toronto
- University of Virginia
- University of Washington
- Wake Forest
Background and VEGA-1
0
5
10
15
20
% with AKI
Perioperative AKI at UCSF
July 2020-Dec 2023
Perioperative Acu te Kidn ey Injury (AKI): Fluids and Vasopressors
8
Acute Kidney Injury (AKI) after major non-cardiac surgery
• UCSF overall 10.5%
• MPOG centers overall 9.0%
(range 6.8 to 12.3%)
Key knowledge gap:
“Can the choice of vasopressor
reduce postoperative AKI?”
Wanderer JP and Rathmell JP (2017) Anesthesiology
▪ NE improves renal
blood flow & outcomes
in septic shock
▪ One RCT has directly
compared these in non-
cardiac, non-obstetric
surgery
→ VEGA-1 Trial
→ UCSF + UCLA 2021
Two 1
st
-line vasopressors with different pharmacodynamics
“Vasopressor of the Month” Trial
VEGA
-1
Supported by
vs.
UCSF · UCLA · ZSFG
Legrand M et al., British Journal of Anaesthesia, 130 (5): 519-527 (2023)
July-December 2021
VEGA-1 Results
Primary Outcome (Compliance)
Overall
0%
20%
40%
60%
80%
100%
Correct 1st-line Vasopressor
Parnassus (n=1660)
Mission Bay (n=612)
Mt. Zion (n=238)
ZSFG (n=550)
UCLA (n=566)
n = 3626 Total
Hospital 1
Hospital 2
Hospital 3
Hospital 4
Hospital 5
Secondary Outcomes
The question remains…
▪ Recent trials and observational studies validate interest and a
continued gap that VEGA-2 will address
VEGA-2 trial overview
▪ Aim to recruit 18,000-36,000 patients over 120 center•months
▪ 10 centers (MPOG sites) across North America, 14 months each (2
months run-in)
▪ 90% power to detect a 1.5% absolute difference in AKI
▪ Intervention:
- Use 1 of 2 first-line vasopressors for INFUSIONS and BOLUSES in major
non-cardiac surgery
▪ Norepinephrine (4-16 mcg/mL)*
▪ Phenylephrine (100-200 mcg/mL)*
* Flexible to comply w/ local pharmacy practices
VEGA-2 Trial Outcomes
• AKI as defined by KDIGO (creatinine-based) criteria
Hospital
Length of Stay
Hypotension
Severe
Hypotension
MINS
VEGA-2 Data Flow & Processing
VEGA-2: broad eligibility
▪ Inclusion criteria
- Age ≥ 18
- Surgery > 2 h under General Anesthesia
▪ Exclusion criteria
- Cardiac, ECMO, obstetric, transplant, or procedures on the kidney
- Outpatient procedures
- ASA status 5 or 6, end-stage renal disease, or on vasopressors prior to surgery
- Local protocol at your Center that recommends a specific vasopressor
▪
Eligibility automatically determined from EMR afterwards
- You don’t have to worry about eligibility of any individual patient
UCSF IRB #23-39683
<Central IRB>
Approved waiver of
individual consent!
Month
1
Month
2
Month
3
Month
4
Month
5
Month
6
Month
7
…
Month
14
UCSF NE PE NE PE NE PE NE PE
Univ. of
Michigan
PE NE PE NE PE NE PE NE
Center #3 NE PE NE PE NE PE NE PE
…
Center #10
NE PE NE PE
VEGA-2: Cluster Randomized Cross-over Design
NE, norepinephrine; PE, phenylephrine
Month
1
Month
2
Month
3
Month
4
Month
5
Month
6
Month
7
…
Month
14+
UCSF NE PE NE PE NE PE NE PE
Univ. of
Michigan
PE NE PE NE PE NE PE NE
Center #3 NE PE NE PE NE PE
…
Center #10
NE PE NE PE
VEGA-2: Cluster Randomized Cross-over Design
NE, norepinephrine; PE, phenylephrine
Month
1
Month
2
Month
3
Month
4
Month
5
Month
6
Month
7
…
Month
14+
UCSF NE PE NE PE NE PE NE PE
Univ. of
Michigan
PE NE PE NE PE NE PE NE
Center #3 NE PE NE PE NE PE
…
Center #10
NE PE NE PE
VEGA-2: Cluster Randomized Cross-over Design
Run-in Period
(1
st
two months)
NE, norepinephrine; PE, phenylephrine
VEGA-2 Current Status
VEGA-2 trial status update
▪ Funding awarded September 2024
▪ As of October 2025:
- 4/10 sites active
▪ UCSF, University of Michigan, University of Virginia, University of Maryland
▪ Adherence is excellent due to the hard work of site PIs and MPOG community
- 2 sites “going live” on 11/1/2025
▪ University of Texas Southwestern, Wake Forest
- Actively onboarding the 4 remaining sites
- 12/120 center•months underway (10% by the end of October!)
- > 6,000* patients included (*this includes pilot months)
Monthly emails at time of vasopressor change
Emails on the 1
st
Monday of each month for vacations the prior week
Morning page the day of the vasopressor change
Badge cards
Posters (ORs, lounges, tech rooms, pharmacy and pharmacy anteroom)
MiChart reminders in the side panel
Reminder cards in OR anesthesia cart clear bins
Reminder cards on the Pyxis
Bin of the “vasopressor-of-the-month” on the pharmacy window ledge
Anesthesia monitor displays
Reminder treats!
VEGA-2 trial status update
VEGA-2 trial status update
▪ Adherence estimates are outstanding
- >84% “vasopressor of the month” adherence across active sites*
▪ *includes pilot months and washout days at the beginning of each month
▪ Intended to include 10 centers (MPOG sites) across North America, 14
months each (2 months run-in) with staggered “go-live”
- Last pair of sites “go-live” by May 2026
- Intervention period will continue through June 2027
Thank You and Questions?
