Author(s)

Joseph R. Whiteley¹, Jason M. Taylor^1*, John J. Freely Jr.¹, Thomas I. Epperson¹, Laura Bell², John L. Murray IV³, Charles F. Bratton⁴, William R. Hand¹

¹Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA.
²Department of Anesthesiology, Columbia University Medical Center, New York, USA.
³Medical University of South Carolina College of Medicine, Charleston, USA.
⁴Department of Surgery, Division of Transplant Surgery, Charleston, USA.

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.

Deceased Donor Renal Transplant, Non-Invasive Goal Directed Fluid Therapy, Delayed Graft Function, Plethysmograph Variability Index

Whiteley, J. , Taylor, J. , Freely Jr., J. , Epperson, T. , Bell, L. , Murray IV, J. , Bratton, C. and Hand, W. (2016) The Effect of Non-Invasive Goal Directed Fluid Administration on Graft Function in Deceased Donor Renal Transplantation: A Pilot Study. Open Journal of Organ Transplant Surgery, 6, 13-21. doi: 10.4236/ojots.2016.63003.