Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF; total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.
References
[1]
Perico, N., et al. (2004) Delayed Graft Function in Kidney Transplantation. The Lancet, 364, 1814-1827. http://dx.doi.org/10.1016/S0140-6736(04)17406-0
[2]
Mallon, D.H., et al. (2013) Defining Delayed Graft Function after Renal Transplantation: Simplest Is Best. Transplantation, 96, 885-889. http://dx.doi.org/10.1097/TP.0b013e3182a19348
[3]
Yarlagadda, S.G., et al. (2008) Marked Variation in the Definition and Diagnosis of Delayed Graft Function: A Systematic Review. Nephrology Dialysis Transplantation, 23, 2995-3003. http://dx.doi.org/10.1093/ndt/gfn158
[4]
Gjertson, D.W. (2002) Impact of Delayed Graft Function and Acute Rejection on Graft Survival. Transplantation Proceedings, 34, 2432. http://dx.doi.org/10.1016/S0041-1345(02)03167-6
[5]
de Vries, D.K., et al. (2013) Oxidative Damage in Clinical Ischemia/Reperfusion Injury: A Reappraisal. Antioxidants & Redox Signaling, 19, 535-545. http://dx.doi.org/10.1089/ars.2012.4580
[6]
Solini, S., et al. (2012) Prolonged Cold Ischemia Accelerates Cellular and Humoral Chronic Rejection in a Rat Model of Kidney Allotransplantation. Transplant International, 25, 347-356. http://dx.doi.org/10.1111/j.1432-2277.2011.01425.x
[7]
Cassis, P., et al. (2014) An Unanticipated Role for Survivin in Organ Transplant Damage. American Journal of Transplantation, 14, 1046-1060. http://dx.doi.org/10.1111/ajt.12677
[8]
Buemi, A., et al. (2014) Is Plasma and Urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) Determination in Donors and Recipients Predictive of Renal Function after Kidney Transplantation? Clinical Biochemistry, 47, 68-72. http://dx.doi.org/10.1016/j.clinbiochem.2014.06.079
[9]
Hollmen, M.E., et al. (2014) Serum Neutrophil Gelatinase-Associated Lipocalin and Recovery of Kidney Graft Function after Transplantation. BMC Nephrology, 15, 123. http://dx.doi.org/10.1186/1471-2369-15-123
[10]
Iguchi, N., et al. (2014) Neutrophil Gelatinase-Associated Lipocalin and Liver-Type Fatty Acid-Binding Protein as Biomarkers for Acute Kidney Injury after Organ Transplantation. Journal of Anesthesia.
[11]
Ronco, C., et al. (2014) Neutrophil Gelatinase-Associated Lipocalin: Ready for Routine Clinical Use? An International Perspective. Blood Purification, 37, 271-285. http://dx.doi.org/10.1159/000360689
[12]
Hollmen, M.E., et al. (2011) Urine Neutrophil Gelatinase-Associated Lipocalin Is a Marker of Graft Recovery after Kidney Transplantation. Kidney International, 79, 89-98. http://dx.doi.org/10.1038/ki.2010.351
[13]
Helfer, M.S., et al. (2014) Incidence, Risk Factors, and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation in a Brazilian Center. Transplantation Proceedings, 46, 1727-1729. http://dx.doi.org/10.1016/j.transproceed.2014.05.026
[14]
Hwang, J.K., et al. (2014) Long-Term Outcomes of Kidney Transplantation from Expanded Criteria Deceased Donors at a Single Center: Comparison with Standard Criteria Deceased Donors. Transplantation Proceedings, 46, 431-436. http://dx.doi.org/10.1016/j.transproceed.2013.11.061
[15]
Nicoletto, B.B., et al. (2014) Effects of Obesity on Kidney Transplantation Outcomes: A Systematic Review and Meta-Analysis. Transplantation, 98, 167-176. http://dx.doi.org/10.1097/TP.0000000000000028
[16]
Ishimura, T., et al. (2014) The Impact of Donor Factors on Early Graft Function in Kidney Transplantation from Donation after Cardiac Death. Transplantation Proceedings, 46, 1064-1066. http://dx.doi.org/10.1016/j.transproceed.2013.11.070
[17]
Carlier, M., Squifflet, J.-P., Pirson, Y., Gribomont, B. and Alexandre, G.P.J. (1982) Maximal Hydration during Anesthesia Increases Pulmonary Arterial Pressures and Improves Early Function of Human Renal Transplants. Transplantation, 34, 201-204. http://dx.doi.org/10.1097/00007890-198210000-00008
[18]
Othman, M.M., Ismael, A.Z. and Hammouda, G.E. (2010) The Impact of Timing of Maximal Crystalloid Hydration on Early Graft Function during Kidney Transplantation. Anesthesia & Analgesia, 110, 1440-1446. http://dx.doi.org/10.1213/ANE.0b013e3181d82ca8
[19]
Gurgel, S.T. and Do Nascimento Jr., P. (2011) Maintaining Tissue Perfusion in High-Risk Surgical Patients: A Systematic Review of Randomized Clinical Trials. Anesthesia & Analgesia, 112, 1384-1391. http://dx.doi.org/10.1213/ANE.0b013e3182055384
[20]
Wakeling, H.G., et al. (2005) Intraoperative Oesophageal Doppler Guided Fluid Management Shortens Postoperative Hospital Stay after Major Bowel Surgery. British Journal of Anaesthesia, 95, 634-642. http://dx.doi.org/10.1093/bja/aei223
[21]
Gan, T.J., et al. (2002) Goal-Directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery. Anesthesiology, 97, 820-826.
[22]
Conway, D.H., Mayall, R., Abdul-Latif, M.S., Gilligan, S. and Tackaberry, C. (2002) Randomised Controlled Trial Investigating the Influence of Intravenous Fluid Titration Using Oesophageal Doppler Monitoring during Bowel Surgery. Anaesthesia, 57, 845-849. http://dx.doi.org/10.1046/j.1365-2044.2002.02708.x
[23]
Michard, F., et al. (2000) Relation between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients with Acute Circulatory Failure. American Journal of Respiratory and Critical Care Medicine, 162, 134-138. http://dx.doi.org/10.1164/ajrccm.162.1.9903035
[24]
Tavernier, B., et al. (1998) Systolic Pressure Variation as a Guide to Fluid Therapy in Patients with Sepsis-Induced Hypotension. Anesthesiology, 89, 1313-1321.
[25]
Perel, A. (1998) Assessing Fluid Responsiveness by the Systolic Pressure Variation in Mechanically Ventilated Patients. Systolic Pressure Variation as a Guide to Fluid Therapy in Patients with Sepsis-Induced Hypotension. Anesthesiology, 89, 1309-1310.
[26]
Shamir, M., Eidelman, L.A., Floman, Y., Kaplan, L. and Pizov, R. (1999) Pulse Oximetry Plethysmographic Waveform during Changes in Blood Volume. British Journal of Anaesthesia, 82, 178-181. http://dx.doi.org/10.1093/bja/82.2.178
[27]
Cannesson, M., et al. (2008) Does the Pleth Variability Index Indicate the Respiratory-Induced Variation in the Plethysmogram and Arterial Pressure Waveforms? Anesthesia & Analgesia, 106, 1189-1194. http://dx.doi.org/10.1213/ane.0b013e318167ab1f
[28]
Natalini, G., et al. (2006) Arterial versus Plethysmographic Dynamic Indices to Test Responsiveness for Testing Fluid Administration in Hypotensive Patients: A Clinical Trial. Anesthesia & Analgesia, 103, 1478-1484. http://dx.doi.org/10.1213/01.ane.0000246811.88524.75
[29]
Wajima, Z., Shiga, T., Imanaga, K. and Inoue, T. (2010) Assessment of the Effect of Rapid Crystalloid Infusion on Stroke Volume Variation and Pleth Variability Index after a Pre-operative Fast. Journal of Clinical Monitoring and Computing, 24, 385-389. http://dx.doi.org/10.1007/s10877-010-9259-8
[30]
Cannesson, M., et al. (2008) Pleth Variability Index to Monitor the Respiratory Variations in the Pulse Oximeter Plethysmographic Waveform Amplitude and Predict Fluid Responsiveness in the Operating Theatre. British Journal of Anaesthesia, 101, 200-206. http://dx.doi.org/10.1093/bja/aen133
[31]
Forget, P., Lois, F. and de Kock, M. (2010) Goal-Directed Fluid Management Based on the Pulse Oximeter-Derived Pleth Variability Index Reduces Lactate Levels and Improves Fluid Management. Anesthesia & Analgesia, 111, 910-914.
[32]
Rao, P.S., et al. (2009) A Comprehensive Risk Quantification Score for Deceased Donor Kidneys: The Kidney Donor Risk Index. Transplantation, 88, 231-236. http://dx.doi.org/10.1097/TP.0b013e3181ac620b
[33]
Corcoran, T., et al. (2012) Perioperative Fluid Management Strategies in Major Surgery: A Stratified Meta-Analysis. Anesthesia & Analgesia, 114, 640-651. http://dx.doi.org/10.1213/ANE.0b013e318240d6eb
[34]
Svensen, C., Ponzer, S. and Hahn, R.G. (1999) Volume Kinetics of Ringer Solution after Surgery for Hip Fracture. Canadian Journal of Anesthesia, 46, 133-141. http://dx.doi.org/10.1007/BF03012547
[35]
Srinivasa, S., Kahokehr, A., Soop, M., Taylor, M. and Hill, A.G. (2013) Goal-Directed Fluid Therapy—A Survey of Anaesthetists in the UK, USA, Australia and New Zealand. BMC Anesthesiology, 13, 5. http://dx.doi.org/10.1186/1471-2253-13-5
[36]
Noblett, S.E., Snowden, C.P., Shenton, B.K. and Horgan, A.F. (2006) Randomized Clinical Trial Assessing the Effect of Doppler-Optimized Fluid Management on Outcome after Elective Colorectal Resection. British Journal of Surgery, 93, 1069-1076. http://dx.doi.org/10.1002/bjs.5454
[37]
Natalini, G., et al. (2006) Variations in Arterial Blood Pressure and Photoplethysmography during Mechanical Ventilation. Anesthesia & Analgesia, 103, 1182-1188.
[38]
Zimmermann, M., et al. (2010) Accuracy of Stroke Volume Variation Compared with Pleth Variability Index to Predict Fluid Responsiveness in Mechanically Ventilated Patients Undergoing Major Surgery. European Journal of Anaesthesiology, 27, 555-561.
[39]
Chappell, D., Jacob, M., Hofmann-Kiefer, K., Conzen, P. and Rehm, M. (2008) A Rational Approach to Perioperative Fluid Management. Anesthesiology, 109, 723-740. http://dx.doi.org/10.1097/ALN.0b013e3181863117
[40]
Benes, J., Giglio, M., Brienza, N. and Michard, F. (2014) The Effects of Goal Directed Fluid Therapy Based on Dynamic Parameters on Post-Surgical Outcome: A Meta-Analysis of Randomized Controlled Trials. Critical Care, 18, 584. http://dx.doi.org/10.1186/s13054-014-0584-z
