Intraoperative fluid management in laparoscopic live-donor nephrectomy: Challenging the dogma
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- Bergman, S., Feldman, L.S., Carli, F. et al. Surg Endosc (2004) 18: 1625. doi:10.1007/s00464-004-8811-3
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Patients undergoing laparoscopic live donor nephrectomy (LLDN) commonly receive large amounts of fluid intraoperatively to counter the negative effects of pneumoperitoneum on renal function. Our aim is to demonstrate that a low-volume fluid management strategy does not adversely affect donor or recipient outcomes.
Fifty-two patients underwent LLDN between December 2000 and January 2004. Data were collected in prospective databases, and augmented with retrospective medical record review. Donors were divided into two groups: the fluid-load group (n = 24) received >10 ml/kg/h of intravenous crystalloids intraoperatively, while the fluid-restriction group (n = 28) received <10 m/kg/h.
Donors in the fluid-restriction group had a lower intraoperative urine output. There were no differences in postoperative creatinine levels (117.5 μmol/L vs 121.5 μmol/L, p = 0.8) or complications (4.2% vs 7.1%, p = 0.9). In the recipients, there were no differences in postoperative creatinine levels up to 12 months, incidence of delayed graft function (18% vs 10%, p = 0.7) or acute rejection (9% vs 5%, p = 1.0) between groups.
Lower volume fluid management strategies in LLDN do not appear to worsen recipient outcomes nor are they detrimental to the donors.