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Cardiac output-based fluid optimization for kidney transplant recipients: a proof-of-concept trial

  • Davide Corbella
  • Patrick Jason Toppin
  • Anand Ghanekar
  • Nour Ayach
  • Jeffery Schiff
  • Adrian Van Rensburg
  • Stuart A. McCluskey
Reports of Original Investigations

Abstract

Purpose

Intravenous fluid management for deceased donor kidney transplantation is an important, modifiable risk factor for delayed graft function (DGF). The primary objective of this study was to determine if goal-directed fluid therapy using esophageal Doppler monitoring (EDM) to optimize stroke volume (SV) would alter the amount of fluid given.

Methods

This randomized, proof-of-concept trial enrolled 50 deceased donor renal transplant recipients. Data collected included patient characteristics, fluid administration, hemodynamics, and complications. The EDM was used to optimize SV in the EDM group. In the control group, fluid management followed the current standard of practice. The groups were compared for the primary outcome of total intraoperative fluid administered.

Results

There was no difference in the mean (standard deviation) volume of intraoperative fluid administered to the 24 control and 26 EDM patients [2,307 (750) mL vs 2,675 (842) mL, respectively; mean difference, 368 mL; 95% confidence interval (CI), − 87 to + 823; P = 0.11]. The incidence of complications in the control and EDM groups was similar (15/24 vs 17/26, respectively; P = 0.99), as was the incidence of delayed graft failure (8/24 vs 11/26, respectively; P = 0.36).

Conclusions

Goal-directed fluid therapy did not alter the volume of fluid administered or the incidence of complications. This proof-of-concept trial provides needed data for conducting a larger trial to determine the influence of fluid therapy on the incidence in DGF in deceased donor kidney transplantation.

Trial registration

www.clinicaltrials.gov (NCT02512731). Registered 31 July 2015.

Gestion optimisée des liquides basée sur le débit cardiaque chez les transplantés rénaux : un essai de preuve de concept

Résumé

Objectif

La gestion des liquides intraveineux pour la transplantation de rein de donneur décédé est un facteur de risque modifiable important du retard de fonctionnement du greffon (DGF). L’objectif principal de cette étude était de déterminer si un traitement liquidien utilisant un monitorage par Doppler transœsophagien (EDM) pour optimiser le volume d’éjection cardiaque modifierait la quantité de liquides administrée.

Méthodes 

Cette étude randomisée de preuve de concept a inclus 50 patients receveurs de greffe de rein provenant de donneurs décédés. Les données collectées ont inclus les caractéristiques démographiques des patients, l’administration de liquides, les données hémodynamiques et les complications. L’EDM a été utilisé pour optimiser le volume d’éjection dans le groupe EDM. Dans le groupe contrôle, la gestion des liquides a suivi les normes de pratique actuelles. Le critère d’évaluation principal qui était la quantité totale de liquide administrée en peropératoire a été comparé entre les groupes.

Résultats

Il n’y a pas eu de différence de volume moyen (écart-type) de liquide administré en cours d’intervention entre les 24 témoins et les 26 patients du groupe EDM (respectivement 2 307 [750] mL contre 2 675 [842] mL; différence des moyennes, 368 mL; intervalle de confiance [IC] à 95 % : − 87 à + 823; P = 0,11). L’incidence des complications a été similaire dans le groupe contrôle et dans le groupe EDM (respectivement, 15/24 contre 17/26; P = 0,99), tout comme l’incidence des échecs tardifs des greffes (respectivement, 8/24 contre 11/26; P = 0,36).

Conclusions

Le traitement avec gestion des liquides axé basé sur l’optimisation du volume d’éjection n’a pas modifié le volume de liquides administrés ou l’incidence des complications. Cette étude de preuve de concept procure les données nécessaires à la réalisation d’une plus grande étude visant à déterminer l’influence du traitement liquidien sur l’incidence du DGF après transplantation rénale de donneur décédé.

Enregistrement de l’essai clinique

www.clinicaltrials.gov (NCT02512731). Enregistré le 31 juillet 2015.

Notes

Acknowledgements

Drs. Hilary Felice and Rohan Kothari initiated the study and developed a recruitment strategy consistent with the recommendations of our Research Ethics Board and principles of informed patient consent.

Davide Corbella and Patrick Jason Toppin were supported by a departmental funding as part of the Abdominal Organ Transplantation Fellowship in Anesthesia in the Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network.

This trial was supported in part by the Dr. Earl Wynands/Fresenius Kabi Research Award from the Canadian Anesthesia Research Foundation. ClinicalTrial.gov number: NCT02512731.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Davide Corbella was responsible for analyzing the data and drafting the first version of the article submitted and the subsequent version. Patrick Jason Toppin developed the protocol. Nour Ayach managed the trial and obtained REB approval. Anand Ghanekar, Jeffery Schiff, Adrian Van Rensburg, and Stuart A. McCluskey developed the protocol and supported the study in their own clinical specialty. All authors participated in the revision and content editing of the manuscript.

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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of Anesthesia and Pain Management, Toronto General HospitalUniversity Health NetworkTorontoCanada
  2. 2.Department of AnesthesiaUniversity of TorontoTorontoCanada
  3. 3.Department of Surgery, Toronto General HospitalUniversity of TorontoTorontoCanada
  4. 4.Department of Medicine, Toronto General HospitalUniversity of TorontoTorontoCanada

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