PURPOSE Isotonic 0.9% sodium chloride (normal saline; NS) solution use is common, but its high chloride content has been shown to contribute to acid-base disturbances and acute kidney injury (AKI). As kidney transplant recipients are at high risk of postoperative AKI and renal replacement therapy, we aimed to evaluate the impact of perioperative NS administration on graft function after kidney transplantation. METHODS All adult patients undergoing deceased-donor kidney transplantation between January 2010 and December 2014 at the Rennes University Hospital were included. Logistic regression models were constructed to evaluate the association of hyperchloremia and hyperchloremic acidosis on delayed graft function (DGF), defined as the need for renal replacement therapy within the first week after transplantation. RESULTS Three hundred and fifty-nine patients were included, 20% developed DGF. The mean (standard deviation) volume of NS infused in the operating room and in the standard postoperative intensive care unit stay was 4,832 (2,242) mL. In the first 24 postoperative hours, 11% of patients developed hyperchloremia and 11% developed hyperchloremic acidosis. These outcomes were not associated with significantly higher total volumes of NS administration or with DGF. In contrast, multivariable analysis showed that cold ischemia time, donor terminal creatinine, and perioperative NS volume were all independent predictors of DGF. CONCLUSION Perioperative NS infusion volume was associated with DGF in deceased-donor kidney transplant recipients. Conversely, postoperative hyperchloremia and hyperchloremic acidosis were not associated with an increased risk of DGF, suggesting other mechanisms than a chloride effect.

中文翻译：

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死者肾脏移植术后围手术期生理盐水与移植物功能延迟之间的关联：一项回顾性观察研究。

用途等渗的0.9％氯化钠（生理盐水； NS）溶液很常见，但已证明其高氯化物含量会导致酸碱紊乱和急性肾损伤（AKI）。由于肾移植接受者术后AKI和肾脏替代治疗的风险很高，因此我们旨在评估围手术期NS给药对肾移植后移植物功能的影响。方法纳入2010年1月至2014年12月在雷恩大学医院接受死者肾移植的所有成年患者。构建了逻辑回归模型以评估高氯血症和高氯酸中毒与延迟移植功能（DGF）的关联，后者被定义为在移植后第一周内需要肾脏替代治疗。结果纳入359例患者，其中20％发展为DGF。在手术室和术后重症监护室标准停留时间中注入的NS的平均（标准差）量为4,832（2,242）mL。在术后的最初24小时内，11％的患者出现高氯血症，11％的患者出现高氯血症酸中毒。这些结果与较高的NS给药总量或DGF无关。相比之下，多变量分析显示冷缺血时间，供体末梢肌酐和围手术期NS量都是DGF的独立预测因子。结论死者肾移植受者的围手术期NS输注量与DGF有关。反过来，