Intraoperative Fluid Restriction is Associated with Functional Delayed Graft Function in Living Donor Kidney Transplantation: A Retrospective Cohort Analysis

• Main Authors: Gertrude J Nieuwenhuijs-Moeke, Tobias M Huijink, Robert A Pol, Mostafa El Moumni, Johannes GM Burgerhof, Michel MRF Struys, Stefan P Berger
• Format: Article
• Language: English
• Published: MDPI AG 2019-10-01
• Series: Journal of Clinical Medicine
• Subjects: fluid management; kidney transplantation; delayed graft function; goal-directed fluid therapy
• Online Access: https://www.mdpi.com/2077-0383/8/10/1587

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&#8722;February 2017 (<i>n</i> = 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 (<i>p</i> &lt; 0.001). Recipients developing fDGF received less intraoperative fluid (36 (25.9&#8722;50.0) mL/kg BW vs. 47 (37.3&#8722;55.6) mL/kg BW (<i>p</i> = 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 (<i>p</i> &lt; 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&#8722;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&#8722;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.