Comparison of Two Different Preload Targets of Stroke Volume Variation During Kidney Transplantation

Comparison of Two Different Preload Targets of Stroke Volume Variation During Kidney Transplantation: A Randomized Controlled Trial

The investigators sought to compare the effect of two preload targets of stroke volume variation of ≤6% and ≤12% on the postoperative renal function in patients undergoing living donor kidney transplantation. Goal-directed fluid therapy will be performed in both groups to maintain adequate stroke volume, stroke volume variation, mean arterial pressure (or systemic vascular resistance) during kidney transplantation. Only the preload target for giving crystalloid during surgery will be different between groups.

The adequate preload target of fluid management has not yet been established during kidney transplantation. Traditionally, sufficient intravascular volume status has been recommended to maintain perfusion to renal graft. Stroke volume variation was reported to be superior to the traditional target of central venous pressure. In this regard, the investigators sought to compare the effect of two preload targets of stroke volume variation of ≤6% and ≤12% on the postoperative renal function in patients undergoing living donor kidney transplantation. Goal-directed fluid therapy will be performed in both groups to maintain adequate stroke volume, stroke volume variation, mean arterial pressure (or systemic vascular resistance) during kidney transplantation. Only the preload target for giving crystalloid during surgery will be different between groups.

The patients do not know which group they will be enrolled. The outcome assessor will be blind to the group assignment of the participants.

The rate of intraoperative fluid administration will be adjusted to achieve the target of Stroke Volume Variation ≤ 6%. A crystalloid bolus of 200 ml will be repeatedly administered every 20 min until the target was achieved. The basal rate of fluid administration will be 3 ml/kg/hr.

The rate of intraoperative fluid administration will be adjusted to achieve the target of Stroke Volume Variation ≤ 12%. A crystalloid bolus of 200 ml will be repeatedly administered every 20 min until the target was achieved. The basal rate of fluid administration will be 3 ml/kg/hr.

The rate of crystalloid fluid administration will be controlled to achieve the target of stroke volume variation ≤ 12%

The rate of crystalloid fluid administration will be controlled to achieve the target of stroke volume variation ≤ 6%

Delayed graft function determined by serum creatinine (No decrease in creatinine of more than 10% of preoperative value)

Inclusion Criteria: Adults patients who are undergoing living donor kidney transplantation with continuous radial artery pressure monitoring Exclusion Criteria: Patients who have cardiac arrhythmia of atrial fibrillation, multiple ventricular premature complex Cardiac systolic dysfunction with left ventricle ejection fraction <50% Continuous arterial pressure monitoring at the site other than radial artery. Patients who are considered to be intolerant to rapid fluid administration