Perioperative fluid management and associated complications in children receiving kidney transplants in the UK,Pediatric Nephrology

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Perioperative fluid management and associated complications in children receiving kidney transplants in the UK
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2022-08-16 , DOI: 10.1007/s00467-022-05690-3
Natalie Wyatt ₁ , Karen Norman ₂ , Kate Ryan ₁ , Mohan Shenoy ₃ , Michal Malina _{4,

5} , Lasanthi Weerassoriya ₆ , Jack Merritt ₆ , Ramnath Balasubramanian ₆ , Wesley Hayes _{1,

7}

Affiliation

Background

Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events.

Methods

Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1^st January 2020 and 31^st December 2021 were included.

Results

Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not.

Conclusions

This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group.

Graphical Abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

在英国接受肾移植的儿童围手术期液体管理和相关并发症

背景

静脉输液是接受肾移植的儿童围手术期护理的重要组成部分。缺乏证据来指导最佳的围手术期液体管理。本研究旨在确定英国 5 个儿科肾移植中心围手术期输液量，并探讨输液量、移植物功能和输液相关不良事件之间的关联。

方法

从五个英国儿科肾移植中心收集了围手术期输液量、肺水肿发生率、全身性高血压和重症监护支持需求的数据。包括在 2020 年 1 月 1 日至 2021 年 12 月³¹日期^间接受了仅肾脏移植的 18 岁以下儿童。

结果

分析了 102 名儿童的完整数据。72 小时内输液总量的中位数为 377 ml/kg（IQR 149 ml/kg），具有高度变异性。注意到总液体体积与第 7 天 eGFR 之间存在负相关关系 ( p < 0.001)。移植后尿量与第 7 天 eGFR 之间的关联也是阴性的 ( p < 0.001)。不良事件很常见，但发生不良事件的患者与未发生不良事件的患者相比，输液量没有显着差异。