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The investigators sought to compare the effect of two preload targets of stroke volume variation of ≤6% and ≤12% on the postoperative renal function in patients undergoing living donor kidney transplantation. Goal-directed fluid therapy will be performed in both groups to maintain adequate stroke volume, stroke volume variation, mean arterial pressure (or systemic vascular resistance) during kidney transplantation. Only the preload target for giving crystalloid during surgery will be different between groups.
The adequate preload target of fluid management has not yet been established during kidney transplantation. Traditionally, sufficient intravascular volume status has been recommended to maintain perfusion to renal graft. Stroke volume variation was reported to be superior to the traditional target of central venous pressure. In this regard, the investigators sought to compare the effect of two preload targets of stroke volume variation of ≤6% and ≤12% on the postoperative renal function in patients undergoing living donor kidney transplantation. Goal-directed fluid therapy will be performed in both groups to maintain adequate stroke volume, stroke volume variation, mean arterial pressure (or systemic vascular resistance) during kidney transplantation. Only the preload target for giving crystalloid during surgery will be different between groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| target of Stroke Volume Variation ≤ 6% | Experimental | The rate of intraoperative fluid administration will be adjusted to achieve the target of Stroke Volume Variation ≤ 6%. A crystalloid bolus of 200 ml will be repeatedly administered every 20 min until the target was achieved. The basal rate of fluid administration will be 3 ml/kg/hr. |
|
| target of Stroke Volume Variation ≤ 12% | Active Comparator | The rate of intraoperative fluid administration will be adjusted to achieve the target of Stroke Volume Variation ≤ 12%. A crystalloid bolus of 200 ml will be repeatedly administered every 20 min until the target was achieved. The basal rate of fluid administration will be 3 ml/kg/hr. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Crystalloid fluid administration with the target of stroke volume variation ≤ 12% | Other | The rate of crystalloid fluid administration will be controlled to achieve the target of stroke volume variation ≤ 12% |
| Measure | Description | Time Frame |
|---|---|---|
| serum neutrophil-gelatinase-associated lipocalin (NGAL) | urine biomarker of renal injury | at the end of surgery |
| Measure | Description | Time Frame |
|---|---|---|
| serum neutrophil-gelatinase-associated lipocalin (NGAL) | urine biomarker of renal injury | at the anesthesia induction procedure |
| Delayed graft function determined by the incidence of hemodialysis |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | 03080 | South Korea |
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A randomized controlled trial of two parallel groups.
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The patients do not know which group they will be enrolled. The outcome assessor will be blind to the group assignment of the participants.
| Crystalloid fluid administration with the target of stroke volume variation ≤ 6% | Other | The rate of crystalloid fluid administration will be controlled to achieve the target of stroke volume variation ≤ 6% |
|
Delayed graft function determined by the incidence of hemodialysis
| during the first postoperative week |
| Delayed graft function determined by urine output (less than 1200 ml) | Delayed graft function determined by urine output (less than 1200 ml) | during the first postoperative day |
| Delayed graft function determined by serum creatinine | Delayed graft function determined by serum creatinine (No decrease in creatinine of more than 10% of preoperative value) | during the 48 hours after surgery |
| Delayed graft function determined by serum creatinine (more than 2.5 mg/dL) | Delayed graft function determined by serum creatinine (more than 2.5 mg/dL) | during the 10 days after surgery |
| Delayed graft function determined by glomerular filtration rate | Delayed graft function determined by glomerular filtration rate (less than 10 ml/min/m2) | during the 24 hours after surgery |
| Delayed graft function determined by serum creatinine (do not decrease less than preoperative value) | Delayed graft function determined by serum creatinine (do not decrease less than preoperative value) | during the first postoperative week |
| Immediate graft function | serum creatinine decrease less than 70% of preoperative value | after eight days after surgery |
| slow graft function | serum creatinine decrease greater than 70% of preoperative value | after eight days after surgery |
| serum creatinine value | serum creatinine value | first postoperative day |
| serum creatinine value | serum creatinine value | third postoperative day |
| serum creatinine value | serum creatinine value | seventh postoperative day |
| Incidence of pneumonia | Incidence of pneumonia | during the first postoperative week |
| Incidence of wound infection | Incidence of wound infection | during the first postoperative week |
| Incidence of postoperative bleeding | Incidence of postoperative bleeding | during the first postoperative week |
| hospital length of stay | hospital length of stay | the first postoperative month |
| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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