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Klonarakis MP, Dhillon M, Sevinc E, Elliott MJ, James MT, Lam NN, McLaughlin KJ, Ronksley PE, Ruzycki SM, Harrison TG. The effect of goal-directed fluid therapy on delayed graft function in kidney transplant recipients: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100834. [PMID: 38335896 DOI: 10.1016/j.trre.2024.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Delayed graft function (DGF) is a common post-operative complication with potential long-term sequelae for many kidney transplant recipients, and hemodynamic factors and fluid status play a role. Fixed perioperative fluid infusions are the standard of care, but more recent evidence in the non-transplant population has suggested benefit with goal-directed fluid strategies based on hemodynamic targets. We searched MEDLINE, EMBASE, Cochrane Controlled Trials Registry and Google Scholar through December 2022 for randomized controlled trials comparing risk of DGF between goal-directed and conventional fluid therapy in adults receiving a living or deceased donor kidney transplant. Effect estimates were reported with odds ratios (OR) and pooled using random effects meta-analysis. We identified 4 studies (205 participants) that met the inclusion criteria. The use of goal-directed fluid therapy had no significant effect on DGF (OR 1.37 95% CI, 0.34-5.6; p = 0.52; I2 = 0.11). Subgroup analysis examining effects among deceased and living kidney donation did not reveal significant differences in the effects of fluid strategy on DGF between subgroups. Overall, the strength of the evidence for goal-directed versus conventional fluid therapy to reduce DGF was of low certainty. Our findings highlight the need for larger trials to determine the effect of goal-directed fluid therapy on this patient-centered outcome.
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Affiliation(s)
| | - Mannat Dhillon
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emir Sevinc
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan J Elliott
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ngan N Lam
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin J McLaughlin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyrone G Harrison
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Baboolal HA, Lane J, Westreich KD. Intraoperative management of pediatric renal transplant recipients: An opportunity for improvement. Pediatr Transplant 2023; 27:e14545. [PMID: 37243426 DOI: 10.1111/petr.14545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Optimal organ perfusion at the time of pediatric renal transplantation is a commonly agreed upon goal. Intraoperative conditions such as fluid balance and arterial pressure determine the success of this goal. Sparse literature guides the anesthesiologist in accomplishing this. We, therefore, hypothesized that significant variability exists in the methods used to optimize renal perfusion during transplantation. METHODS A literature search was performed to assess what guidelines currently exist to optimize intraoperative renal perfusion. The intraoperative practice pathways of six large children's hospitals in North America were obtained to compare suggested guidelines. A retrospective chart review of anesthesia records was performed of all pediatric renal transplants over 7 years at the University of North Carolina. RESULTS There did not appear to be agreement between the various publications in terms of standard intraoperative monitoring, specific blood pressure or central venous pressure goals, and fluid management. The practice pathways of six children's hospitals showed significant variation and lack of a consensus-driven approach. The chart review demonstrated significant variation between anesthesiologists in terms of invasive monitoring, fluid management, hemodynamic goals, vasopressor use, and analgesic choices. However, children <30 kg were significantly more likely to have arterial lines and epidural catheters placed prior to surgery. CONCLUSION Significant variation exists across centers of expertise and even within centers of expertise with regard to the intraoperative management of pediatric kidney transplant recipients. In the era of enhanced recovery after surgery, this presents an opportunity to develop consensus on an evidence-based approach to optimize initial organ perfusion during surgery.
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Affiliation(s)
- Hemanth A Baboolal
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joelle Lane
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katie D Westreich
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
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Mahajan N, Heer MK, Trevillian PR. Renal transplant anastomotic time-Every minute counts! Front Med (Lausanne) 2023; 9:1024137. [PMID: 36743673 PMCID: PMC9889534 DOI: 10.3389/fmed.2022.1024137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/28/2022] [Indexed: 01/20/2023] Open
Abstract
The impact of anastomotic time in renal transplant is under recognized and not well studied. It is one of the few controllable factors that affect the incidence of delayed graft function (DGF). Our study aimed at quantifying the impact of anastomotic time. We performed a retrospective review of 424 renal transplants between the years 2006 and 2020. A total of 247 deceased donor renal transplants formed the study cohort. Patients were divided into two groups based on the presence or absence of DGF. Variables with p < 0.3 were analyzed using the binary logistic regression test. The final analysis showed anastomotic time to be significantly associated with DGF with odds ratio of 1.04 per minute corresponding to 4% increase in DGF incidence with every minute increment in anastomotic time. Other variables that had significant impact on DGF were DCD donor (odds ratio - 8.7) and donor terminal creatinine. We concluded that anastomotic time had significant impact on the development of DGF and hence should be minimized.
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Affiliation(s)
- Nikhil Mahajan
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Munish K. Heer
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, New Lambton Heights, NSW, Australia,Hunter Transplant Research Foundation, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia,*Correspondence: Munish Heer,
| | - Paul R. Trevillian
- Hunter Transplant Research Foundation, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Raveh Y, Nicolau-Raducu R. Prolonged cold ischemia and kidney donation after cardiac death. Clin Transplant 2022; 36:e14678. [PMID: 35499283 DOI: 10.1111/ctr.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yehuda Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Miami, Florida, 33136, USA
| | - Ramona Nicolau-Raducu
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Miami, Florida, 33136, USA
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