Effect of Preoperative Donor Hydration on Outcomes in Living Donor Renal Transplantation: A Prospective Randomised Study

Objectives: Living renal donors do not usually undergo preoperative hydration, which may cause subclinical graft renal injury. We planned a prospective randomised study to determine the effect of preoperative renal donor hydration on intraoperative graft parameters, neutrophil gelatinase-associated lipocalin (NGAL) levels, and other complications. Materials and Methods: Living donor renal transplantation pairs were randomised into two groups: Group 1 donors (controls) were fasting overnight with no hydration from 11 pm to 7 am , while Group 2 donors were fasting with preoperative hydration (2 L of intravenous Ringer’s lactate) from 11 pm to 7 am . The primary outcome parameter was positive graft ischaemia (PGI), deemed positive when at least two were present: visible graft discolouration, renal arterial spasm, reduction in urine output before and after division of ureter, and, flaccidity of the graft. Results: The two groups were comparable in demographic, clinical parameters including graft function. PGI was present in 7/32 (22%), with no significant differences between the groups. Mean NGAL levels were lower in Group 2 without statistical significance. There was a significant correlation between PGI and proportion of functional delayed graft function (85% versus 36%; P = 0.03), but not between of PGI and warm ischaemia time (WIT – 55.57 ± 10.86 min vs 50.32 ± 13.14; P = 0.342), cold ischaemia time (CIT – 32.14 ± 9.12 vs 26.53 ± 11.58; P = 0.204), or mean urinary NGAL (30.67 ± 1.97 ng/mL versus 28.67 ± 2.65 ng/mL; P = 0.78). Conclusion: Preoperative donor hydration may decrease perioperative subclinical renal injury, but more studies with larger sample size are required.