Journal Article

Impact of restrictive fluid balance focused to increase lung procurement on renal function after kidney transplantation

Eduardo Miñambres, Emilio Rodrigo, Maria Angeles Ballesteros, Javier Llorca, Juan Carlos Ruiz, Gema Fernandez-Fresnedo, Ana Vallejo, Julio González–Cotorruelo and Manuel Arias

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 7, pages 2352-2356
Published in print July 2010 | ISSN: 0931-0509
Published online February 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq054
Impact of restrictive fluid balance focused to increase lung procurement on renal function after kidney transplantation

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Background. Restrictive management of fluid status has been proposed to increase the rates of lung grafts available for transplant. However, no studies have supported the effect of this negative fluid balance in the kidney graft recipients.

Methods. We evaluated the effect of restrictive fluid balance in brain-dead donors and their impact in 404 kidney recipients using Kaplan–Meier curves and Cox regression for long-term effects, and logistic regression for short-term effects. Our primary interest was graft survival and the second was occurrence of delayed graft function (DGF).

Results. A negative or equalized fluid balance with a central venous pressure (CVP) <6 mm Hg affects neither graft survival in kidney recipients (P = 0.983) nor the development of DGF (P = 0.573). A positive fluid balance between brain death and organ retrieval does not reduce either the risk of graft survival or the risk of DGF.

Conclusion. We concluded that restrictive management of fluid balance in a multiorgan donor supports adequate perfusion to vital organ systems even with a CVP <6 mm Hg. A strict fluid balance could avoid volume overload and lung neurogenic oedema, increasing the rate of lung grafts available for transplant without impacting either kidney graft survival or DGF development.

Keywords: brain-dead donors; central venous pressure; delayed graft function; fluid management; graft survival

Journal Article.  3600 words. 

Subjects: Nephrology

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