Impact of restrictive fluid balance focused to increase lung procurement on renal function after kidney transplantation.
BACKGROUND
Restrictive management of fluid status has been proposed to increase the rates of lung grafts available for transplant. However, no studies have supported the effect of this negative fluid balance in the kidney graft recipients.


METHODS
We evaluated the effect of restrictive fluid balance in brain-dead donors and their impact in 404 kidney recipients using Kaplan-Meier curves and Cox regression for long-term effects, and logistic regression for short-term effects. Our primary interest was graft survival and the second was occurrence of delayed graft function (DGF).


RESULTS
A negative or equalized fluid balance with a central venous pressure (CVP) <6 mm Hg affects neither graft survival in kidney recipients (P = 0.983) nor the development of DGF (P = 0.573). A positive fluid balance between brain death and organ retrieval does not reduce either the risk of graft survival or the risk of DGF.


CONCLUSIONS
We concluded that restrictive management of fluid balance in a multiorgan donor supports adequate perfusion to vital organ systems even with a CVP <6 mm Hg. A strict fluid balance could avoid volume overload and lung neurogenic oedema, increasing the rate of lung grafts available for transplant without impacting either kidney graft survival or DGF development.
Service of Intensive Care, Universitary Hospital Marqués de Valdecilla-IFIMAV, Santander, Spain. eminambres@yahoo.es
Eduardo
E
Miñambres
Emilio
E
Rodrigo
Maria Angeles
MA
Ballesteros
Javier
J
Llorca
Juan Carlos
JC
Ruiz
Gema
G
Fernandez-Fresnedo
Ana
A
Vallejo
Julio
J
González-Cotorruelo
Manuel
M
Arias
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014882:Water-Electrolyte Balance