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Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

Lookup NU author(s): Dr Michal Malina

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2022, The Author(s). Background: Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events. Methods: Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included. Results: Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not. Conclusions: This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group. Graphical Abstract: A higher resolution version of the Graphical abstract is available as Supplementary information [Figure not available: see fulltext.].


Publication metadata

Author(s): Wyatt N, Norman K, Ryan K, Shenoy M, Malina M, Weerassoriya L, Merritt J, Balasubramanian R, Hayes W

Publication type: Article

Publication status: Published

Journal: Pediatric Nephrology

Year: 2022

Pages: Epub ahead of print

Online publication date: 16/08/2022

Acceptance date: 07/07/2022

Date deposited: 23/09/2022

ISSN (print): 0931-041X

ISSN (electronic): 1432-198X

Publisher: Springer Nature

URL: https://doi.org/10.1007/s00467-022-05690-3

DOI: 10.1007/s00467-022-05690-3

PubMed id: 35972538


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Funding

Funder referenceFunder name
NIHR Great Ormond Street Hospital Biomedical Research Centre

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