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Review
. 2021 Aug 1;105(8):1677-1684.
doi: 10.1097/TP.0000000000003581.

Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists

Gebhard Wagener  1 , Dmitri Bezinover  2 , Cynthia Wang  3 , Elizabeth Kroepfl  4 , Geraldine Diaz  5 , Chris Giordano  6 , James West  7 , James D Kindscher  8 , Marina Moguilevitch  9 , Ramona Nicolau-Raducu  10 , Raymond M Planinsic  11 , David M Rosenfeld  12 , Scott Lindberg  13 , Roman Schumann  14 , Evan G Pivalizza  15
Affiliations
Review

Fluid Management During Kidney Transplantation: A Consensus Statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists

Gebhard Wagener et al. Transplantation. .

Abstract

Background: Intraoperative fluid management may affect the outcome after kidney transplantation. However, the amount and type of fluid administered, and monitoring techniques vary greatly between institutions and there are limited prospective randomized trials and meta-analyses to guide fluid management in kidney transplant recipients.

Methods: Members of the American Society of Anesthesiologists (ASA) committee on transplantation reviewed the current literature on the amount and type of fluids (albumin, starches, 0.9% saline, and balanced crystalloid solutions) administered and the different monitors used to assess fluid status, resulting in this consensus statement with recommendations based on the best available evidence.

Results: Review of the current literature suggests that starch solutions are associated with increased risk of renal injury in randomized trials and should be avoided in kidney donors and recipients. There is no evidence supporting the routine use of albumin solutions in kidney transplants. Balanced crystalloid solutions such as Lactated Ringer are associated with less acidosis and may lead to less hyperkalemia than 0.9% saline solutions. Central venous pressure is only weakly supported as a tool to assess fluid status.

Conclusions: These recommendations may be useful to anesthesiologists making fluid management decisions during kidney transplantation and facilitate future research on this topic.

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Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

References

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