Perioperative fluid management in renal transplantation: a narrative review of the literature

Abstract

Summary Adequate volume maintenance is essential to prevent acute renal failure during major surgery or to ensure graft function after renal transplantation. The various recommendations on the optimum fluid therapy are based, at best, on sparse evidence only from observational studies. This article reviews the literature on perioperative fluid management in renal transplantation. Crystalloid solutions not exerting any specific side‐effects are the first choice for volume replacement in kidney transplantation. The use of colloids should be restricted to patients with severe intravascular volume deficits necessitating high volume restoration. The routine application of albumin, dopamine, and high dose diuretics is no longer warranted. Mannitol given immediately before removal of the vessel clamps reduces the requirement of post‐transplant dialysis, but has no effects on graft function in the long term. There is insufficient evidence on the best use of dialysis, but it seems peritoneal dialysis pretransplant is associated with less delayed graft function, whereas the preference of dialysis post‐transplant is not yet well‐founded. This review article should provide better guidance for fluid management in kidney transplantation until best‐evidence guidelines can be established based upon more research.

Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

“…Two small randomized trials - one in patients with pre-existing normal renal function [65], the second in patients with established renal dysfunction [66] - did not find differences for any measured variable of renal function. More convincing are the results obtained with the preventive administration of mannitol, just before clamp release, during renal transplantation [67,68]. The sparse controlled data available have shown that 250 ml of 20% mannitol given immediately before vessel clamp removal reduces the incidence of post-transplant AKI, as indicated by a lower requirement of post-transplant dialysis.…”

Anesthesia for Kidney Transplantation-A Review

“…Colloids may be considered in recipients with severe intravascular volume deficits who require high-volume resuscitation [49]. Albumin, a normal endogenous colloid with a wide safety margin is recommended with large fluid deficit.…”

“…Albumin, a normal endogenous colloid with a wide safety margin is recommended with large fluid deficit. Synthetic colloids that have widely replaced albumin in clinical practice; dextrans, gelatins and solutions of hetastarch; do not seem to be preferable to albumin [49]. Colloids have been reported to adversely affect renal function and may increase bleeding complications [50].…”

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

“…(4,5) These parameters can be achieved with the vigorous infusion of crystalloid solutions (C). (20) Eventually, the use of excessive fluid infusion becomes of value to avoid the use of vasopressors (D). (21,22) However, no controlled or retrospective studies have been done that specifically address the ideal method of fluid replacement for deceased donors.…”