Comparison of Different Rates of Intraoperative Fluid Therapy on Early Graft Function during Live Related Renal Transplantation

Renal transplantation is now being recognized as treatment of choice for patients of end stage renal disease. Several studies in the previous decades have shown that the hemodynamic status of the patient during transplantation have effect on graft function . Early graft function is crucial for successful kidney transplantation. Many factors affect graft function. Some of them are donor age, donor hypertension, prolonged anastomosis time, preoperative dialysis with too much ul­trafiltration causing volume contraction in the recipient and pelvic atherosclerosis . Prolonged cold ischemia time and warm ischemia time also have significant effect on graft function. Among all the factors affecting graft outcome, recipient hydration status at time of de-clamping of the vessels after graft anastomosis is also an important factor for the development of delayed graft function. For proper functioning of graft in early post-operative period, it is necessary that graft is adequately perfused at the time of operation.

Patient with chronic renal failure have narrow margin of safety with intravenous hydration and may oscillate between hypovolemia and hypervolemia . Fluid given too fast may theoretically lead to cardiac decompensation and signs of fluid overload in patients with poor cardiac function while on the other hand fluid restriction may lead to hypotension and acidosis in patients with chronic renal failure . Thus intravascular volume and arterial blood pressure needs to be carefully adjusted for effective perfusion of graft as well as to avoid over hydrating the patient. Traditionally fluid replacements for patients undergoing surgery is done according to volume deficit due to overnight fasting, maintenance fluid therapy according to Segar’s formula, intraoperative losses and third space losses . Fluid given according to above calculation may be redistributed by the time of declamping of vessels leading to inadequate graft perfusion. This study, thus has been planned to compare the different fluid hydration regimens, traditional fluid replacement method and targeted fluid replacement before declamping of renal vessels, on early graft function during live related renal transplantation. This study will also evaluate if different regimens will have any hemodynamic or metabolic side effects.