Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists

Abstract

Background. Intraoperative fluid management may affect the outcome after kidney transplantation. However, the amount and type of fluid administered, and monitoring techniques vary greatly between institutions and there are limited prospective randomized trials and meta-analyses to guide fluid management in kidney transplant recipients. Methods. Members of the American Society of Anesthesiologists (ASA) committee on transplantation reviewed the current literature on the amount and type of fluids (albumin, starches, 0.9% saline, and balanced crystalloid solutions) administered and the different monitors used to assess fluid status, resulting in this consensus statement with recommendations based on the best available evidence. Results. Review of the current literature suggests that starch solutions are associated with increased risk of renal injury in randomized trials and should be avoided in kidney donors and recipients. There is no evidence supporting the routine use of albumin solutions in kidney transplants. Balanced crystalloid solutions such as Lactated Ringer are associated with less acidosis and may lead to less hyperkalemia than 0.9% saline solutions. Central venous pressure is only weakly supported as a tool to assess fluid status. Conclusions. These recommendations may be useful to anesthesiologists making fluid management decisions during kidney transplantation and facilitate future research on this topic.

Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

“…The surgical procedure of kidney transplantation is generally performed under general anesthesia and presents significant challenges for the anesthesiologist (Martinez et al 2013 ). A careful anesthetic approach is highly recommended to improve outcomes (Martinez et al 2013 ; De Gasperi et al 2014 ; Mittel and Wagener, 2017 ; Wagener et al 2020 ). The management of neuromuscular block (NMB) deserves particular attention (Martinez et al 2013 ; Mittel and Wagener, 2017 ) in order to reduce the incidence of complications due to postoperative residual NMB (De Gasperi et al 2014 ; Miskovic and Lumb, 2017 ).…”

Effects of the Type of Intraoperative Fluid in Living Donor Kidney Transplantation: A Single-Center Retrospective Cohort Study

“…Recently, a balanced crystalloid solution has shown a better metabolic profile and is preferred in kidney transplantation. 27 …”

A Pilot Study on the Association Between Early Fluid Status Indicators After Kidney Transplantation and Graft Function Recovery

“…Previous studies have demonstrated that optimal perioperative fluid therapy was associated with a lower incidence of delayed graft function after kidney transplantation [2][3][4] . Contrary to earlier studies, large volume administration is no longer recommended, and an individualized approach is now encouraged to balance the graft perfusion and the possible complications of fluid overload 5 .…”