Goal-Directed Haemodynamic Therapy Improves Patient Outcomes in Kidney Transplantation

• Published in: Progress in transplantation (Aliso Viejo, Calif.) Vol. 33; no. 2; pp. 150 - 155
• Main Authors: Fabes, Jez, Al Midani, Ammar, Sarna, Aman S, Hadi, Dina H, Naji, Saqib A, Banga, Neal R, Jones, Gareth L, Berry, Peter D, Wittenberg, Marc D
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-06-2023
• Subjects: Adult; Fluid Therapy - methods; Goals; Hemodynamics - physiology; Humans; Kidney Transplantation; Renal Dialysis; Retrospective Studies; cardiac output; goal-directed therapy; perioperative care; renal transplant; kidney transplant; enhanced recovery; anaesthesia
• ISSN: 1526-9248; 2164-6708
• DOI: 10.1177/15269248231164165

Introduction: Kidney transplant graft function depends on optimised haemodynamics. However, high fluid volumes risk hypervolaemic complications. The Edwards Lifesciences ClearSight™ device permits fluid titration through markers of preload and beat-to-beat blood pressure monitoring. We evaluated the implementation of a novel goal-directed haemodynamic therapy protocol to determine whether patient outcomes had improved. Design: A retrospective evaluation of standard care versus goal-directed haemodynamic therapy in adults undergoing kidney transplantation was performed in a single centre between April 2016 and October 2019. Twenty-eight standard-of-care patients received intraoperative fixed-rate infusion and 28 patients received goal-directed haemodynamic therapy. The primary outcome was volume of fluid administered intraoperatively. Secondary outcomes included blood product and vasoactive drug exposure, graft and recipient outcomes. Results: Intraoperative fluid administered was significantly reduced in the goal-directed haemodynamic therapy cohort (4325 vs 2751 ml, P < .001). Exposure to vasopressor (67.9% vs 42.9%, P = .060) and blood products (17.9% vs 3.6%, P = .101) was unchanged. Immediate graft function (82.1% vs 75.0%, P = .515), dialysis requirement (14.3% vs 21.4%, P = .729) and creatinine changes post-operatively were unchanged. In the goal-directed haemodynamic therapy cohort, 1 patient had pulmonary oedema (3.6%) versus 21.4% in the standard cohort. Patients in the goal-directed haemodynamic therapy group were more likely to mobilise within 48 hours of surgery (number needed to treat = 3.5, P = .012). Conclusions: Protocolised goal-directed haemodynamic therapy in kidney transplantation was safe and may improve patient, graft, and surgical outcomes. Clinical trials assessing goal-directed approaches are needed.