The Impact of Intraoperative Fluid Management During Laparoscopic Donor Nephrectomy on Donor and Recipient Outcomes

Aaron M Williams, Sathish S Kumar, Umar F Bhatti, Ben E Biesterveld, Ranganath G Kathawate, Randall S Sung, Kenneth J Woodside, Michael J Englesbe, Mitchell B Alameddine, Seth A Waits
Clinical Transplantation 2019 March 19, : e13542

BACKGROUND: Intraoperative fluid management during laparoscopic donor nephrectomy (LDN) may have a significant effect on donor and recipient outcomes. We sought to quantify variability in fluid management and investigate its impact on donor and recipient outcomes.

METHODS: A retrospective review of patients who underwent LDN from July 2011 to January 2016 with paired kidney recipients at a single center was performed. Patients were divided into tertiles of intraoperative fluid management (standard, high, and aggressive). Donor and recipient demographics, intraoperative data, and postoperative outcomes were analyzed.

RESULTS: Overall, 413 paired kidney donors and recipients were identified. Intraoperative fluid management (ml/hr) was highly variable with no correlation to donor weight (kg) (R=0.017). The aggressive fluid management group had significantly lower recipient creatinine levels on postoperative day 1. However, no significant differences were noted in creatinine levels out to 6 months between groups. No significant differences were noted in recipient postoperative complications, graft loss, and death. There was a significant increase (P < 0.01) in the number of total donor complications in the aggressive fluid management group.

CONCLUSIONS: Aggressive fluid management during LDN does not improve recipient outcomes and may worsen donor outcomes compared to standard fluid management. This article is protected by copyright. All rights reserved.


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