Effect of intraoperative human albumin on early graft function in renal transplantation.
Adequate intravascular volume maintenance is essential to ensure early graft function during renal transplantation. Various recommendations on optimum fluid therapy are based, at best, on sparse evidence, and that too only from observational studies. This prospective randomized controlled study was done to evaluate the effect of 20% human albumin on the early graft function in living donor renal transplantation. Eighty patients undergoing renal transplantation were randomly assigned to one of the intraoperative fluid regimens, 0.9% normal saline with 20% human albumin (albumin group) or 0.9% normal saline alone (saline group), after confirming the exclusion criteria. Intravenous fluid infusion was given to keep central venous pressure (CVP) between 12 to 15 mm Hg. The statistical package of social sciences, SPSS version 12, was used for statistical analysis. The intraoperative fluid volume infused [albumin group--3381±1021.2 vs. saline group--3487±978.5 (mL)] to maintain target CVP was comparable between the two groups (P value>0.05). Statistically, no significant difference was found between the two groups in terms of post transplant serum creatinine [day one; 2.76±1.0 vs. 2.58±0.94, day three; 1.48±0.53 vs. 1.43±0.71, day seven; 1.42±0.6 vs. 1.42±0.53 (mg/dL)] and urine output [day one; 13122.5±5767.8 vs. 13909.4±5324.7, day three; 9233.9±3267.4 vs. 9250±4794.2, day seven; 7517.6±3043.6 vs. 6921.4±3170 (mL)] (P value>0.05). Postoperative change in body weight [1.89±3.82 vs. 2.48±3.89 (kg)], tissue edema (10% vs. 7.5%), and pulmonary edema (2.5% vs. 5%) did not differ significantly (P>0.05). Twenty percent human albumin given intraoperatively, as a volume expander, does not improve early graft function in living donor renal transplantation. It should be used selectively rather than as a routine protocol.
Department of Anesthesiology and Critical Care, Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India.
Rajkiran Babubhai
RB
Shah
Veena Rasiklal
VR
Shah
Beena Prashant
BP
Butala
Geeta Piyush
GP
Parikh
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002496:Central Venous Pressure; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000008:administration & dosage* / Q000009:adverse effects; D000075462:Serum Albumin, Human; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination; D055815:Young Adult
C422455:ALB protein, human; D015415:Biomarkers; D010952:Plasma Substitutes; D012709:Serum Albumin; D012965:Sodium Chloride; D003404:Creatinine; D000075462:Serum Albumin, Human