Intraoperative fluid management and kidney transplantation outcomes: A retrospective cohort study

Abstract

Background Patients undergoing kidney transplantation traditionally receive liberal amounts of fluid during surgery. However, excessive fluids can lead to fluid overload and ileus. In this retrospective cohort study, we compared the effect of restrictive versus liberal fluid therapy on kidney transplantation outcomes. Methods Patients who underwent deceased‐donor kidney transplantation at Mayo Clinic from January 2014 to March 2019 were included. Those who received <3 L of intravenous fluids intraoperatively were categorized as “restrictive;” those who received ≥3 L were categorized as “liberal.” The primary outcome was incidence of delayed graft function (DGF). Secondary outcomes included length of stay, readmission within 30 days, time to return of bowel function, and incidence of postoperative complications. Results Of the 1171 patients included, 557 were in the restrictive group and 614 in the liberal group. The mean (SD) fluid intake was 2.17 (.54) L in the restrictive group and 3.67 (.68) L in the liberal group (P<.001). There was no difference in DGF (relative risk, 1.03; P = .56), length of stay (P = .34), readmission (P = .80), return of bowel function (P = .71), or other postoperative complications. Conclusions Intraoperative restrictive fluid therapy during kidney transplantation was not associated with DGF or worse outcomes when compared with liberal fluid therapy.

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

“…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.…”

Intraoperative central venous pressures related to early graft function in deceased donor kidney transplant recipients with low immunological risks

“…On behalf of targeting high CVP, individualized goaldirected uid therapy, which is not based on CVP, is suggested to be the preferred method for optimizing the uid management 18 . However, it is also true that there is a possibility of hypoperfusion occurring when individualization is attempted, so there are questions about whether a target should be set when performing uid management 19 .…”