Delayed graft function (DGF) is defined as requirement for dialysis in the first week following kidney transplantation. DGF is a common complication occurring in 39% of the deceased donor renal transplants at the investigators' institution with significant cost and outcome implications. The 3 major risk factors for DGF are donor graft characteristics, recipient factors and perioperative management. The most easily modifiable of these factors is perioperative management, in particular intraoperative fluid therapy. The investigators propose to compare the amount of fluid administered using the current standard of care with the fluid administered when optimizing the cardiac output (CO) using Esophageal Doppler Monitoring (EDM) to guide fluid therapy. EDM measures blood flow in the descending aorta, optimizing stroke volume (SV) and cardiac output (CO) by indicating when fluid administration fails to produce an increase in CO.

Inclusion Criteria:

• age greater than 18 years
• signed informed consent
• listed for deceased donor transplantation.

Exclusion Criteria:

• esophageal surgery or cancer
• esophageal stricture, varices or diverticulum
• upper airway surgery
• coarctation of the aorta
• significant valvular heart disease
• clinically significant cardiac arrhythmias
• patient randomized to other trials with an outcome variable of delayed graft function or early graft function will also be excluded