title: Effect of intraoperative transesophageal Doppler-guided fluid therapy versus central venous pressure-guided fluid therapy on renal allograft outcome in patients undergoing living donor renal transplant surgery: a comparative study.
abstract: OBJECTIVE
  Transesophageal Doppler (TED)-guided intraoperative fluid therapy has shown to noninvasively optimize intravascular volume and reduce postoperative morbidity. The aim of this study was to compare the effects of Doppler-guided intraoperative fluid administration and central venous pressure (CVP)-guided fluid therapy on renal allograft outcome and postoperative complications.
  
  
  METHODS
  A prospective nonrandomized active controlled study was conducted on end-stage renal disease patients scheduled for living donor renal transplant surgery. 110 patients received intraoperative fluid guided by corrected flow time (FTc) and variation in stroke volume values obtained by continuous TED monitoring. Data of 104 patients in whom intraoperative fluid administration was guided by CVP values were retrospectively obtained for a control.
  
  
  RESULTS
  The amount of intraoperative fluid given in the study group (12.20 ± 4.24 ml/kg/h) was significantly lower than in the controls (22.21 ± 4.67 ml/kg/h). The amount of colloid used was also significantly less and fewer recipients were seen to require colloid (69 vs 85%). The mean arterial pressures were comparable throughout. CVP reached was 7.18 ± 3.17 mmHg in the study group. It was significantly higher in the controls (13.42 ± 3.12 mmHg). The postoperative graft function and rate of dysfunction were comparable. Side-effects like postoperative dyspnoea (4.8 vs 0%) and tissue edema (9.6 vs 2.7%) were higher in the controls.
  
  
  CONCLUSIONS
  FTc-guided intraoperative fluid therapy achieved the same rate of immediate graft function as CVP-guided fluid therapy but used a significantly less amount of fluid. The incidence of postoperative complications related to fluid overload was also reduced. The use of TED may replace invasive central line insertions in the future.
authors.affiliation: Department of Anaesthesiology, UP Rural Institute of Medical Sciences & Research, Safai, Etawah, 206130, UP, India. dr.divshri@gmail.com.
authors.forename: Divya
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Abhilash
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Tiwari
authors.affiliation: Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Singh
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D002496:Central Venous Pressure; D015150:Echocardiography, Doppler / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013318:Stroke Volume
keywords: Corrected flow time; Renal transplant; Stroke volume; Transesophageal doppler