Intraoperative Fluid Restriction is Associated with Functional Delayed Graft Function in Living Donor Kidney Transplantation: A Retrospective Cohort Analysis
| Autor: | Johannes G. M. Burgerhof, Gertrude J. Nieuwenhuijs-Moeke, Michel Struys, Mostafa El Moumni, Tobias M. Huijink, Stefan P Berger, Robert A. Pol |
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| Přispěvatelé: | Groningen Institute for Organ Transplantation (GIOT), Groningen Kidney Center (GKC), Life Course Epidemiology (LCE), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
SURGERY medicine.medical_treatment Urology lcsh:Medicine kidney transplantation goal-directed fluid therapy RENAL BLOOD-FLOW 030204 cardiovascular system & hematology 030230 surgery ACUTE REJECTION Lower risk CENTRAL VENOUS-PRESSURE Article 03 medical and health sciences 0302 clinical medicine delayed graft function Medicine and Health Sciences medicine CARDIAC-OUTPUT PREDICTORS Dialysis Kidney transplantation POSTISCHEMIC INJURY Univariate analysis OUTCOMES business.industry lcsh:R Central venous pressure HEMODYNAMIC THERAPY Retrospective cohort study General Medicine medicine.disease ISCHEMIA Regimen fluid management Renal blood flow business |
| Zdroj: | Journal of Clinical Medicine, 8(10):1587. MDPI AG Journal of Clinical Medicine Volume 8 Issue 10 Journal of Clinical Medicine, Vol 8, Iss 10, p 1587 (2019) JOURNAL OF CLINICAL MEDICINE |
| ISSN: | 2077-0383 |
| Popis: | 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&ndash 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&ndash 50.0) mL/kg BW vs. 47 (37.3&ndash 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&ndash 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&ndash 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. |
| Databáze: | OpenAIRE |
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