Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation

Michelet, D.; Brasher, Christopher; Marsac, Lucile; Zanoun, Nabil; Assefi, Mona; El-Ghoneimi, Alaa; Dauger, Stéphane; Dahmani, Souhayl

doi:10.1111/pan.13201

Cited by 17 publications

(34 citation statements)

References 31 publications

(62 reference statements)

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“…Fluid administration was 158 [124‐191] mL kg −1 in the first two patients. It decreased to 80 (18) [44‐106] mL kg −1 in the last 10 patients, which is 23 (8) mL kg −1 less than the 103 (61) mL kg −1 of crystalloids found by Michelet and co‐authors (95% CI = 6‐40 mL kg −1 ; P = .01). They also reported 16 (14) mL kg −1 albumin being given apart from the crystalloids.…”

Section: Resultsmentioning

confidence: 61%

“…Moreover, higher CVP levels and fluid overload are associated with higher risks of acute kidney injury, renal replacement therapy, and mortality in critically ill children . In a retrospective analysis, postoperative renal replacement therapy was related to high volumes of intra‐operative fluid administration related to body weight and a higher donor‐recipient weight ratio . This supports the idea that CVP‐guided fluid administration may lead to tissue edema, especially in small children.…”

Section: Discussionmentioning

confidence: 59%

“…A two‐sample t ‐test for groups with unequal variances (Welch's test) was used to compare intraoperative fluids given to our last 10 patients with those reported in two recent papers on intraoperative management in pediatric kidney transplantation …”

Section: Methodsmentioning

confidence: 99%

“…It is uncertain how to guarantee sufficient blood flow through the transplanted kidney, as evidence‐based guidelines do not exist. Hemodynamic therapy protocols commonly advise liberal fluid administration guided by high target central venous pressure (CVP) and arterial blood pressure (ABP) . However, ABP and CVP are known to poorly reflect CO and organ blood flow or predict fluid responsiveness .…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, such therapy may lead to good renal outcomes, but the risk of fluid overload is substantial. This is illustrated by the high incidence of pulmonary edema, prolonged ventilator support, and renal replacement therapy in these patients …”

Section: Introductionmentioning

confidence: 99%

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Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Voet

Nusmeier

Lerou

et al. 2019

Pediatric Anesthesia

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Background A living‐donor (adult) kidney transplantation in young children requires an increased cardiac output to maintain adequate perfusion of the relatively large kidney. To achieve this, protocols commonly advise liberal fluid administration guided by high target central venous pressure. Such therapy may lead to good renal outcomes, but the risk of tissue edema is substantial. Aims We aimed to evaluate the safety and feasibility of the transpulmonary thermodilution technique to measure cardiac output in pediatric recipients. The second aim was to evaluate whether a cardiac output‐guided hemodynamic therapy algorithm could induce less liberal fluid administration, while preserving good renal results and achieving increased target cardiac output and blood pressure. Methods In twelve consecutive recipients, cardiac output was measured with transpulmonary thermodilution (PiCCO device, Pulsion). The algorithm steered administration of fluids, norepinephrine and dobutamine. Hemodynamic values were obtained before, during and after transplantation. Results are given as mean (SD) [minimum‐maximum]. Results Age and weight of recipients was 3.2 (0.97) [1.6‐4.9] yr and 14.1 (2.4) [10.4‐18] kg, respectively. No complications related to cardiac output monitoring occurred. After transplantation, cardiac index increased with 31% (95% CI = 15%‐48%). Extravascular lung water and central venous pressure did not change. Fluids given decreased from 158 [124‐191] mL kg−1 in the first 2 patients to 80 (18) [44‐106] mL kg−1 in the last 10 patients. The latter amount was 23 mL kg−1 less (95% CI = 6‐40 mL kg−1) than in one recent study, but similar to that in another. After reperfusion, all patients received norepinephrine (maximum dose 0.45 (0.3) [0.1‐0.9] mcg kg−1 min−1). Patient and graft survivals were 100% with excellent kidney function at 6 months post‐transplantation. Conclusion Transpulmonary thermodilution‐cardiac output monitoring appeared to be safe and feasible. Using the cardiac output‐guided algorithm led to excellent renal results with a trend toward less fluids in favor of norepinephrine.

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Section: Resultsmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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