Utility of central venous pressure measurement in renal transplantation: Is it evidence based?

Abstract

Adequate intravenous fluid therapy is essential in renal transplant recipients to ensure a good allograft perfusion. Central venous pressure (CVP) has been considered the cornerstone to guide the fluid therapy for decades; it was the only available simple tool worldwide. However, the revolutionary advances in assessing the dynamic preload variables together with the availability of new equipment to precisely measure the effect of intravenous fluids on the cardiac output had created a question mark on the future role of CVP. Despite the critical role of fluid therapy in the field of transplantation. There are only a few clinical studies that compared the CVP guided fluid therapy with the other modern techniques and their relation to the outcome in renal transplantation. Our work sheds some light on the available published data in renal transplantation, together with data from other disciplines evaluating the utility of central venous pressure measurement. Although lager well-designed studies are still required to consolidate the role of new techniques in the field of renal transplantation, we can confidently declare that the new techniques have the advantages of providing more accurate haemodynamic assessment, which results in a better patient outcome.

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

“…The high target CVP advocated in literature was abandoned, aiming for less liberal fluid administration. This accords with many reports questioning the use of CVP as a reliable monitor of fluid status in adults . Based upon our experience with advanced hemodynamic monitoring in children, we chose the transpulmonary thermodilution (TPTD) technique to measure CO as this technique has been validated and is designated as the gold standard in children …”

“…TA B L E 3 Values of hemodynamic variables obtained at three different time points: pre-transplantation (t0), post-reperfusion (t1) and in the intensive care unit, without hemodynamic support (t2) (n = 12) (2) , .008 (3) , .002 (4) , .154 (5) , .472 (6) , <.0001 (7) , >.999 (8) , .003 (9) , .001 (10) , .007 (11) and .0007 (12) . c CVP was obtained in 10 patients at 2 times points; the difference between values for CVP was not statistically significant (Student's t-test for paired data: P = .76).…”

“…This accords with many reports questioning the use of CVP as a reliable monitor of fluid status in adults. 8 Based upon our experience with advanced hemodynamic monitoring in children, we chose the transpulmonary thermodilution (TPTD) technique to measure CO as this technique has been validated and is designated as the gold standard in children. 9,10 As this is the first report on TPTD-CO monitoring during LDKT with large donor-recipient size mismatch, our first goal was to evaluate the safety and feasibility of the technique and analyze the hemodynamic changes.…”

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

“…These factors include operating table position, which is not always flat and the surgeon may left or right tilt it to have more access to the iliac vessels, the pressure effect of surgical retractors on the abdominal viscera and venous return, and the positive pressure ventilation during the procedure that can also affect venous return. [ 20 ] Systematic reviews revealed a weak correlation between CVP and blood volume, as well as CVP's inability to predict hemodynamic responses to a fluid challenge. [ 21 22 ]…”

To compare intraoperative goal directed fluid therapy by trans-oesophageal Doppler vis-à-vis FloTrac™ in patients undergoing living related renal transplantation-a prospective randomised controlled study

“…[ 12 13 ] This invented newer dynamic indices based GDFT to accurately assess fluid responsiveness. [ 14 15 ] These newer techniques along with adequate haemodynamic optimisation in various high-risk surgeries including transplantation had improved the early recovery and significantly reduced the postoperative complications. [ 16 17 ] In renal transplant recipients, even CFT (TED) guided fluid therapy had proven better outcomes to CVP with lesser side effects.…”