Comparison of Two Different Preload Targets of Stroke Volume Variation During Kidney Transplantation

Seoul National University Hospital60 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Kidney Transplant; Complications

Interventions

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%

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%

Eligibility

Sex: ALLMin age: 20 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults patients who are undergoing living donor kidney transplantation with continuous radial artery pressure monitoring Exclusion Criteria: * Patients who have cardiac arrhythmia of atrial fibrillation, multiple ventricular premature complex * Cardiac systolic dysfunction with left ventricle ejection fraction \<50% * Continuous arterial pressure monitoring at the site other than radial artery. * Patients who are considered to be intolerant to rapid fluid administration

Locations (1)

Seoul National University Hospital

Seoul, South Korea

Outcomes

Primary Outcomes

serum neutrophil-gelatinase-associated lipocalin (NGAL)

urine biomarker of renal injury

Time frame: at the end of surgery

Secondary Outcomes

serum neutrophil-gelatinase-associated lipocalin (NGAL)

urine biomarker of renal injury

Time frame: at the anesthesia induction procedure

Delayed graft function determined by the incidence of hemodialysis

Time frame: during the first postoperative week

Delayed graft function determined by urine output (less than 1200 ml)

Time frame: 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)

Time frame: during the 48 hours after surgery

Delayed graft function determined by serum creatinine (more than 2.5 mg/dL)

Time frame: 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)

Time frame: during the 24 hours after surgery

Delayed graft function determined by serum creatinine (do not decrease less than preoperative value)

Time frame: during the first postoperative week

Immediate graft function

serum creatinine decrease less than 70% of preoperative value

Time frame: after eight days after surgery

slow graft function

serum creatinine decrease greater than 70% of preoperative value

Time frame: after eight days after surgery

serum creatinine value

Time frame: first postoperative day

serum creatinine value

Time frame: third postoperative day

serum creatinine value

Time frame: seventh postoperative day

Incidence of pneumonia

Time frame: during the first postoperative week

Incidence of wound infection

Time frame: during the first postoperative week

Incidence of postoperative bleeding

Time frame: during the first postoperative week

hospital length of stay

Time frame: the first postoperative month

Data from ClinicalTrials.gov

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