Pulse pressure variation-guided intraoperative fluid management in kidney transplant recipients

Background: Despite advances in perioperative fluid management in kidney transplantation, the best strategy to provide individualized need and response to volume therapy remains unclear. A pulse pressure variation (PPV) is a well-established hemodynamic monitoring parameter for evaluating fluid responsiveness during perioperative fluid administration in major high-risk surgeries. Methods: A total of 70 American Society of Anesthesiologists (ASA) physical status grade III patients, aged 20 to 65 years, who underwent living donor kidney transplant surgery between September 2018 and April 2021 were enrolled in this hospital-based, comparative study. Every 35 patients were allotted into two groups: group P was managed with PPV and received 100 mL of crystalloid bolus whenever the value was greater than 13%, while group C patients received the same amount and type of fluid if the central venous pressure (CVP) was less than 10 mmHg. All patients received 4 mL/kg/hr of maintenance fluid. Results: Fluid requirement was significantly different between group P and group C (1,764.86274.88 mL vs. 2,059.71240.02 mL, P<0.001), as well as mean CVP (9.030.85 mmHg vs. 11.140.22 mmHg, P<0.001), without difference in inotrope requirement. Hemoglobin, hematocrit, and bicarbonate significantly decreased, while lactate and chloride substantially increased in all patients. Blood pH decreased in CVP patients but was stable in PPV patients. The percent changes in hemoglobin, hematocrit, blood pH, and chloride differed significantly between groups. Urinary output was significantly increased, while serum creatinine and blood urea nitrogen decreased considerably from baseline. Between the groups, the percent change in creatinine was more in PPV and differed significantly though no statistically significant difference in blood urea nitrogen and urine output. Conclusions: This study revealed that pulse pressure variation was an effective and safe perioperative hemodynamic guiding predictor providing better biochemical parameters while maintaining graft function in fluid management of kidney transplant recipients.