Intraoperative fluid management in laparoscopic live-donor nephrectomy: challenging the dogma.
BACKGROUND
Patients undergoing laparoscopic live donor nephrectomy (LLDN) commonly receive large amounts of fluid intraoperatively to counter the negative effects of pneumoperitoneum on renal function. Our aim is to demonstrate that a low-volume fluid management strategy does not adversely affect donor or recipient outcomes.


METHODS
Fifty-two patients underwent LLDN between December 2000 and January 2004. Data were collected in prospective databases, and augmented with retrospective medical record review. Donors were divided into two groups: the fluid-load group (n = 24) received > 10 ml/kg/h of intravenous crystalloids intraoperatively, while the fluid-restriction group (n = 28) received < 10 m/kg/h.


RESULTS
Donors in the fluid-restriction group had a lower intraoperative urine output. There were no differences in postoperative creatinine levels (117.5 micromol/L vs 121.5 micromol/L, p = 0.8) or complications (4.2% vs 7.1%, p = 0.9). In the recipients, there were no differences in postoperative creatinine levels up to 12 months, incidence of delayed graft function (18% vs 10%, p = 0.7) or acute rejection (9% vs 5%, p = 1.0) between groups.


CONCLUSIONS
Lower volume fluid management strategies in LLDN do not appear to worsen recipient outcomes nor are they detrimental to the donors.
Bergman
S
S
Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, H3G 1A4, Canada.
Feldman
L S
LS
Carli
F
F
Anidjar
M
M
Vassiliou
M C
MC
Andrew
C G
CG
Stanbridge
D D
DD
Fried
G M
GM
D000328:Adult; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies