Fluid management in renal transplantation: Is it time to move towards goal-directed directed therapy?

Abstract

Achieving optimal fluid balance for a patient undergoing major surgery, especially transplant surgery, has always been the lofty goal of peri-operative care,1 which often proves to be an elusive target. While keeping the patient well hydrated improves organ perfusion, being too generous with fluids can result in morbidity, such as venous congestion and tissue oedema. On the flip side, keeping the patient less than well hydrated may potentially reduce blood loss, but water deprivation exposes organs to the risk of injury. The complex process of achieving optimal fluid management is further amplified in renal transplantation, where the interplay of different factors such as tissue oedema leading to vascular anastomotic failure against acute tubular necrosis from intraoperative hypotension and dehydration, creates a convoluted puzzle waiting to unfold. One can no longer rely on the traditional goal of achieving an adequate urine output but rather, depend on other markers to gauge the patient's fluid status.