A systematic review and meta-analysis on the effect of goal-directed fluid therapy on postoperative outcomes in renal transplantation surgeries

This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature. A systematic search of patients aged ≥18 y...

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Bibliographic Details
Published in:	Annals of the Academy of Medicine, Singapore Vol. 52; no. 12; pp. 679 - 694
Main Authors:	Choo, Caitlin Lmc, Law, Lawrence Sc, How, Wen Jie, Goh, Benjamin Ys, Ashokka, Balakrishnan
Format:	Journal Article
Language:	English
Published:	Singapore 28-12-2023
Subjects:	Creatinine - blood Edema - etiology Edema - prevention & control Fluid Therapy - methods Humans Intraoperative Care - methods Kidney Transplantation Postoperative Complications - epidemiology Postoperative Complications - prevention & control Renal Dialysis - methods postoperative outcomes end-stage renal failure goal-directed therapy systematic review renal transplantation
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Summary:	This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature. A systematic search of patients aged ≥18 years who have undergone single-organ primary renal transplantations up to June 2022 in PubMed, Embase, Scopus and CINAHL Plus was performed. Primary outcome examined was postoperative renal function. Secondary outcomes assessed were mean arterial pressure at graft reperfusion, intraoperative fluid volume and other postoperative complications. Heterogeneity was tested using I² test. The study protocol was registered on PROSPERO. A total of 2459 studies were identified. Seven eligible studies on 607 patients were included. Subgroup assessments revealed potential renal protective benefits of GDT, with patients receiving cadaveric grafts showing lower serum creatinine on postoperative days 1 and 3, and patients monitored with arterial waveform analysis devices experiencing lower incidences of postoperative haemodialysis. Overall analysis found GDT resulted in lower incidence of tissue oedema (risk ratio [RR] 0.34, 95% CI 0.15-0.78, P=0.01) and respiratory complications (RR 0.39, 95% CI 0.17-0.90, P=0.03). However, quality of data was deemed low given inclusion of non-randomised studies, presence of heterogeneities and inconsistencies in defining outcomes measures. While no definitive conclusions can be ascertained given current limitations, this review highlights potential benefits of using GDT in renal transplantation recipients. It prompts the need for further standardised studies to address limitations discussed in this review.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 ObjectType-Review-4 content type line 23
ISSN:	0304-4602 2972-4066 2972-4066 0304-4602
DOI:	10.47102/annals-acadmedsg.202367