The incidence of delayed graft function in patients undergoing kidney transplantation remains significant. Optimal fluid therapy has been shown to decrease delayed graft function after renal transplantation. Traditionally, the perioperative volume infusion regimen in this patient population has been guided by central venous pressure as an estimation of the patient’s volume status and mean arterial pressure, but this is based on sparse evidence from mostly retrospective observational studies. Excessive volume infusion to the point of no further fluid responsiveness can damage the endothelial glycocalyx and is no longer considered to be the best approach. However, achievement of adequate flow to maintain sufficient tissue perfusion without maximization of cardiac filling remains a challenge. Novel minimally invasive technologies seem to reliably assess volume responsiveness, heart function and perfusion adequacy. Prospective comparative clinical studies are required to better understand the use of dynamic analyses of flow parameters for adequate fluid management in kidney transplant recipients. We review perioperative fluid assessment techniques and discuss conventional and novel monitoring strategies in the kidney transplant recipient.
Schnuelle P, Johannes van der Woude F. Perioperative fluid management in renal transplantation: a narrative review of the literature. Transpl Int. 2006;19(12):947–59.
Halloran PF, Hunsicker LG. Delayed graft function: state of the art, November 10-11, 2000. Summit meeting, Scottsdale, Arizona, USA. Am J Transplant. 2001;1(2):115–20. PubMed
Tóth M, Reti V, Gondos T. Effect of recipients’ peri-operative parameters on the outcome of kidney transplantation. Clin Transplant. 1998;12(6):511–7. PubMed
Gentil MA, Castro de la Nuez P, Gonzalez-Corvillo C, de Gracia MC, Cabello M, Mazuecos MA, et al. Non-heart-beating donor kidney transplantation survival is similar to donation after brain death: comparative study with controls in a regional program. Transplant Proc. 2016;48(9):2867–70. CrossRefPubMed
Ferris RL, Kittur DS, Wilasrusmee C, Shah G, Krause E, Ratner L. Early hemodynamic changes after renal transplantation: determinants of low central venous pressure in the recipients and correlation with acute renal dysfunction. Med Sci Monit. 2003;9(2):CR61–6. PubMed
Cocchi MN, Kimlin E, Walsh M, Donnino MW. Identification and resuscitation of the trauma patient in shock. Emerg Med Clin North Am. 2007;25(3):623–42. vii.
Braunwald E, Ross Jr J, Sonnenblick EH. Mechanisms of contraction of the normal and failing heart. N Engl J Med. 1967;277(15):794–800. contd.
Srivastava D, Sahu S, Chandra A, Tiwari T, Kumar S, Singh PK. Effect of intraoperative transesophageal Doppler-guided fluid therapy versus central venous pressure-guided fluid therapy on renal allograft outcome in patients undergoing living donor renal transplant surgery: a comparative study. J Anesth. 2015;29(6):842–9. CrossRefPubMed
Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311(21):2181–90. CrossRefPubMed
- Perioperative fluid management in kidney transplantation: a black box
Maria Helena Calixto Fernandes
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II