Perioperative fluid management in kidney transplantation: What’s new and future directives?

Abstract

Kidney transplantation is a moderate to high-risk surgery, and postoperative outcome is closely related to good intraoperative fluid management. Suboptimal fluid management is adversely associated with poor graft and recipient outcomes. Hence, meticulous intraoperative fluid management is essential and requires in-depth knowledge of newly added fluids and hemodynamic tools for fluid monitoring. Over the years, fluid management during kidney transplant has significantly changed with the inclusion of newer fluids and dynamic indices of volume responsiveness. In this review, we will discuss the different types of fluids and hemodynamic tools available for perioperative fluid management in kidney transplantation and their pros and cons on postoperative outcomes.

Keywords: Fluid therapy; Kidney transplantation; Perioperative period; Crystalloid solutions; Haemodynamic; Central venous pressure

Core Tip: Fluid therapy is one of the core domains of intraoperative anaesthesia management in kidney transplantation. Newer advancements in recent years have changed the outlook of intraoperative hemodynamic monitoring, resulting in better transplant outcomes. In this review, we focused on discussing newer indices of fluid responsiveness and their utility in kidney transplant surgery, as well as newer crystalloids and colloids and their impact on metabolic profile and post-transplant graft outcomes.