Intraoperative Fluid Restriction is Associated with Functional Delayed Graft Function in Living Donor Kidney Transplantation: A Retrospective Cohort AnalysisNieuwenhuijs-Moeke, G. J., Huijink, T. M., Pol, R. A., El Moumni, M., Burgerhof, J. G. M., Struys, M. M. R. F. & Berger, S. P., Oct-2019, In : Journal of Clinical Medicine. 8, 10, 14 p., 1587.
Research output: Contribution to journal › Article › Academic › peer-review
Background: In 2016 we observed a marked increase in functional delayed graft function (fDGF) in our living donor kidney transplantation (LDKT) recipients from 8.5% in 2014 and 8.8% in 2015 to 23.0% in 2016. This increase coincided with the introduction of a goal-directed fluid therapy (GDFT) protocol in our kidney transplant recipients. Hereupon, we changed our intraoperative fluid regimen to a fixed amount of 50 mL/kg body weight (BW) and questioned whether the intraoperative fluid regimen was related to this increase in fDGF. Methods: a retrospective cohort analysis of all donors and recipients in our LDKT program between January 2014-February 2017 (n = 275 pairs). Results: Univariate analysis detected various risk factors for fDGF. Dialysis dependent recipients were more likely to develop fDGF compared to pre-emptively transplanted patients (p <0.001). Recipients developing fDGF received less intraoperative fluid (36 (25.9-50.0) mL/kg BW vs. 47 (37.3-55.6) mL/kg BW (p = 0.007)). The GDFT protocol resulted in a reduction of intraoperative fluid administration on average by 850 mL in total volume and 21% in mL/kg BW compared to our old protocol (p <0.001). In the unadjusted analysis, a higher intraoperative fluid volume in mL/kg BW was associated with a lower risk for the developing fDGF (OR 0.967, CI (0.941-0.993)). After adjustment for the confounders, prior dialysis and the use of intraoperative noradrenaline, the relationship of fDGF with fluid volume was still apparent (OR 0.970, CI (0.943-0.998)). Conclusion: Implementation of a GDFT protocol led to reduced intraoperative fluid administration in the LDKT recipients. This intraoperative fluid restriction was associated with the development of fDGF.
|Number of pages||14|
|Journal||Journal of Clinical Medicine|
|Publication status||Published - Oct-2019|
- fluid management, kidney transplantation, delayed graft function, goal-directed fluid therapy, CENTRAL VENOUS-PRESSURE, RENAL BLOOD-FLOW, HEMODYNAMIC THERAPY, POSTISCHEMIC INJURY, ACUTE REJECTION, CARDIAC-OUTPUT, OUTCOMES, PREDICTORS, ISCHEMIA, SURGERY