title: Can stroke volume variation be an alternative to central venous pressure in patients undergoing kidney transplantation?
abstract: BACKGROUND
  Stroke volume variation (SVV) is known to be a simple and less invasive hemodynamic parameter for evaluating fluid responsiveness and preload status. Central venous pressure (CVP) has been targeted to achieve an adequate level for improving the graft perfusion and long-term graft function in kidney transplantation (KT) recipients, despite the various potential complications. The aim of this study was to investigate whether SVV could substitute for CVP in guiding intravascular volume management during KT.
  
  
  METHODS
  This retrospective study evaluated 635 patients who underwent KT because of end-stage renal disease. Hemodynamic variables including CVP and SVV were obtained before skin incision (T1), 5 minutes after iliac vein clamping (T2), and 10 minutes after renal graft reperfusion (T3). The ability of SVV to predict CVP level was investigated with receiver operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  CVPs were 6.0 ± 2.6, 8.6 ± 2.7, and 9.3 ± 2.5 mm Hg, and SVVs were 6.9 ± 3.0, 5.0 ± 2.1, and 4.3 ± 2.1% at T1, T2, and T3, respectively. ROC analysis showed that the discriminative power of SVV was fairly good with an area under the ROC curve of 0.70 (95% confidence interval, 0.67-0.72) for a CVP of 8 mm Hg, and that an optimal cutoff value of SVV was 6% as an alternative to CVP of 8 mm Hg during KT.
  
  
  CONCLUSIONS
  SVV may replace CVP in the volume management of patients who have undergone KT. Our results suggest that SVV can guide volume management to improve graft perfusion at critical time points during KT.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Chin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: I-G
authors.initials: IG
authors.lastname: Jun
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: H
authors.initials: H
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: G-S
authors.initials: GS
authors.lastname: Hwang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: kyk@amc.seoul.kr.
authors.forename: Y-K
authors.initials: YK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002496:Central Venous Pressure; D051799:Delayed Graft Function / Q000503:physiopathology*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D013318:Stroke Volume