The Effect of Non-Invasive Goal Directed Fluid Administration on Graft Function in Deceased Donor Renal Transplantation: A Pilot Study

Joseph R Whiteley,John L Murray Iv,Jason M Taylor,John J Freely Jr,William R Hand,Charles F Bratton,Laura Bell,Thomas I Epperson

doi:10.4236/ojots.2016.63003

Abstract

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.

Highlights

Delayed graft function (DGF), a form of acute kidney injury occurring immediately after renal transplantation, affects 2% - 50% of deceased donor kidney transplant recipients [1]
As a secondary analysis we examined the association between the biomarker neutrophil gelatinase associated lipocalin (NGAL) levels and total amount of intravenous fluid (IVF) given, Treatment group designation, and occurrence of delayed graft function (DGF)
Over aggressive or targeted IVF intraoperative fluid administration often exacerbates post-operative risk profile. This pilot study set out to evaluate the feasibility of a goal directed fluid administration protocol based on Plethysmograph Variability Index (PVI) with the goal of decreasing the incidence of DGF in primary deceased donor kidney transplant recipients

Summary

Introduction

Delayed graft function (DGF), a form of acute kidney injury occurring immediately after renal transplantation, affects 2% - 50% of deceased donor kidney transplant recipients [1]. 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. The Treatment group received a baseline IVF infusion throughout the surgery. Primary end point was DGF; total IVF administration and urinary biomarker NGAL levels were secondary endpoints. 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

Methods

Results

Discussion

Conclusion