Early perioperative fluid overload is associated with adverse outcomes in deceased donor kidney transplantation

Jia, Hanying; Huang, Fuhan; Zhang, Xing; Cheng, Jian; Chen, Jianghua; Wu, Jiang

doi:10.1111/tri.13926

Cited by 6 publications

(4 citation statements)

References 43 publications

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“…Fluid management is one such factor. In adult transplant recipients, judicious use of fluids was found to be beneficial [ 4 , 5 ], but there is a high degree of variability in fluid management strategies used, with no consensus on the most advantageous approach [ 6 ]. There is also a paucity of high-quality evidence to guide optimal perioperative fluid management in children receiving kidney transplants.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

Wyatt

Norman²,

Ryan

et al. 2022

Pediatr Nephrol

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Background Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events. Methods Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included. Results Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not. Conclusions This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information

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Section: Introductionmentioning

confidence: 99%

“…Fig 4. Comparison between the median volumes of fluid administered in total in ml/kg between children who did or did not experience an adverse event during the postoperative period…”

mentioning

confidence: 99%

Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

Wyatt

Norman²,

Ryan

et al. 2022

Pediatr Nephrol

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“…Optimum perioperative fluid administration with adequate intravascular volume maintenance is essential to improve outcomes in critically ill patients, prevent acute organ failure or dysfunction, and improve immediate graft function after KTA and SPKT [ 19 , 21 , 31 , 32 , 33 , 34 , 35 ]. Determination of the perfect amount of fluid therapy is highly challenging in critically ill patients, as well as in the perioperative phase during operations with a high fluid turnover.…”

Section: Discussionmentioning

confidence: 99%

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Sucher

Schiemanck

Hau

et al. 2022

JCM

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Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas–kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1–10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0–4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.

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“…However, analyzing data from a cohort of first deceased-donor KT recipients, an elegant study from the University Hospital of Gent, demonstrated that pre-transplant PD and optimized (slightly positive) peri-operative fluid balance were independent predictors of immediate graft function [107]. As a matter of fact, recent data indicate that graft function is more likely affected by intra-operative and early post-operative fluid loads rather than by chronic hydration [108,109]. The RRF at the time of transplant may also play a role [110,111].…”

Section: Delayed Graft Functionmentioning

confidence: 99%

Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

et al. 2022

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Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient’s needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.

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Early perioperative fluid overload is associated with adverse outcomes in deceased donor kidney transplantation

Cited by 6 publications

References 43 publications

Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

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