The impact of intraoperative targeting of the central venous pressure on the onset of diuresis in living donor kidney transplantation

Abstract

Introduction: Early graft function is very important and can be achieved with an adequate intraoperative perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting CVP on the onset of diuresis in kidney transplantation. Material and methods: The patients were divided in 2 groups of thirty patients: group A receiving normal saline intraoperatively, targeting for CVP 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. The hemodynamic changes were recorded as systolic, diastolic and mean arterial pressure in 4 times: T0 before the induction, T1 after induction, T2 before the clamping the vessels and T3 after unclamping. We also recorded the duration of surgery, the duration of cold and warm ischemia, and the amount of normal saline until the unclamping of the vessels, lactates at the end of the surgery and total urine output from unclamping the renal vessels to the end of the surgery in both groups. We were monitoring the administration of plasma expander, dopamine and furosemide (if higher than 40mg) and we were inspecting if any tissue edema occurred. Results: There were no statistically significant differences in intraoperative hemodynamic parameters between both groups. The onset of diuresis in seconds was insignificantly longer in group B p>0.05 (p=0.31). The average value of postoperative levels of the lactate showed that in group B the level of the lactate were significantly higher for Z=-5.79 and p<0.001 (p=0.000). Conclusion: CVP as a guide for volume substitution is still highly recommended in kidney transplantation. The fact that in group B (the constant infusion group) we had 5 (16.7%) patients in whom we didn’t achieved urine output at the end of the surgery and the level of lactate was higher in group B gives us the right to conclude that targeting higher CVP, promotes diuresis and better urine output at the end of the surgery.