Intravenous Fluid Management Practices in Kidney Transplant Patients: A Multicenter Observational Cohort Pilot Study

Abstract

Background Limited evidence exists with regard to best practices in fluid management during kidney transplantation, which may directly affect the incidence of DGF. The authors of this study embarked on a collaborative observational multicenter pilot study to evaluate fluid administration practices in different transplant centers, with a focus on the relationship between total administered crystalloid volume and its association with DGF. Methods Twenty consecutive kidney transplant patients were included from 9 academic medical centers in the United States. One hundred eighty patients were included in the final cohort and variables were compared between patients with and without DGF. Administered crystalloid volume was the primary variable of interest; however, additional patient and surgical variables were compared between patients with and without DGF. Variation in crystalloid administration was explored between centers by comparing median administered crystalloid volumes per kilogram of body weight. Also, unadjusted and adjusted logistic regression analyses were performed to determine which variables were independently associated with DGF. Results Multivariable regression modeling demonstrated that cold ischemic time and ephedrine use during surgery were independently associated with DGF. There was no independent association between administered crystalloid volume and DGF. Conclusion In this study of patients having kidney transplantation, we did not find an independent association between administered crystalloid volume and DGF, although there was significant variability in crystalloid administration between centers. Our data suggest that DGF was driven mainly by surgical factors such as cold ischemic time. Ephedrine was also independently associated with DGF, which should be explored in future studies.

Crystalloid fluids and delayed graft function in kidney transplant: A cohort study

“…The intraoperative crystalloid volume was similar in patients who developed or did not develop DGF, and this was similar to the findings of a recent multicenter pilot study. [ 16 ] In the present study, CVP was slightly elevated at the end of surgery in the non-DGF group, but this was not statistically conclusive. Studies on CVP as a volume guide in kidney transplant showed inconsistent results, with many studies advising maximal hydration[ 17 ] and high CVP to ensure good graft function,[ 18 ] whereas other studies observed an association between high CVP and DGF[ 5 ] and advised against supranormal volume loading, especially in cardiac patients with poor myocardial function.…”

Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study

“…This is in accordance with a national trend. 12 The marked increase in delayed graft function between 2005 and 2013 (Supplemental Digital Content 3, http:// links.lww.com/ALN/C656) has previously been reported. 26 This is attributed to the increasing utilization of expanded criteria donors in an effort to meet the high demand of kidney donations.…”

“…[5][6][7]9,10 Based on these results, some institutions and providers worldwide have already shifted away from normal saline in kidney transplantation. 12 In contrast, the effects of normal saline administration on clinical outcomes, especially on kidney graft function, remain unclear. In fact, none of the cited randomized trials was powered to detect a meaningful difference in function of the grafted kidney.…”

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.…”