Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.08.015
Brazilian Journal of Anesthesiology
Original Investigation

Effects of Plasma-Lyte® and 0.9% saline in renal function after deceased-donor kidney transplant: a randomized controlled trial

Efeitos do Plasma-Lyte® e solução salina a 0,9% na função renal após transplante renal de doador falecido: um estudo controlado randomizado

Paulo do Nascimento Junior, Lucas Esteves Dohler, Cindy Midori Uchida Ogawa, Luís Gustavo Modelli de Andrade, Leandro Gobbo Braz, Norma Sueli Pinheiro Módolo

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Abstract

Background
The influence of different crystalloid solutions infused during deceased-donor kidney transplant on the incidence of delayed graft function remains unclear. We investigated the influence of Plasma-Lyte® vs. 0.9% saline on the incidence of delayed graft function in deceased-donor kidney transplant recipients.

Methods
We conducted a single-blind randomized controlled trial of 104 patients aged 18 to 65 years who underwent deceased-donor kidney transplant under general anesthesia. Patients were randomly assigned to receive either Plasma-Lyte® (n = 52) or 0.9% saline (n = 52), at the same infusion volume, for intraoperative fluid replacement. The primary outcome was the occurrence of delayed graft function. Secondary outcomes included metabolic and electrolytic changes at the end of surgery.

Results
Two patients in the Plasma-Lyte® group and one in the 0.9% saline group died postoperatively and were not included for analysis. The incidence of delayed graft function in Plasma-Lyte® and 0.9% saline groups were 60.0% (95% Confidence Interval [95% CI 46.2–72.4]) and 74.5% (95% CI 61.1–84.4), respectively (p = 0.140). Mean (standard deviation) values of immediate postoperative pH and serum chloride levels in Plasma-Lyte® and 0.9% saline groups were 7.306 (0.071) and 7.273 (0.061) (p = 0.013), and 99.6 (4.2) mEq.L-1 and 103.3 (5.6) mEq.L-1, respectively (p < 0.001). All other postoperative metabolic and electrolyte variables were not statistically different at the immediate postoperative period (p > 0.05).

Conclusion
In deceased-donor kidney transplant recipients, the incidence of delayed graft function is not influenced by Plasma-Lyte® or 0.9% saline used for intraoperative fluid replacement.

Keywords

Anesthesia;  Crystalloid solutions;  Delayed graft function;  Kidney transplantation;  Electrolytes;  Acid-base equilibrium

Resumo

Justificativa: A influência de diferentes soluções cristalóides infundidas durante o transplante renal de doador falecido na incidência de função tardia do enxerto permanece incerta. Nós investigamos a influência do Plasma-Lyte® vs. solução salina 0,9% na incidência de função tardia do enxerto em receptores de transplante renal de doador falecido. Métodos: Foi realizado um estudo controlado randomizado simples-cego de 104 pacientes com idades entre 18 e 65 anos submetidos a transplante renal de doador falecido sob anestesia geral. Os pacientes foram aleatoriamente designados para receber Plasma-Lyte® (n=52) ou solução salina 0,9% (n=52), no mesmo volume de infusão, para reposição de fluidos no intraoperatório. O desfecho primário foi a ocorrência de função tardia do enxerto. Os desfechos secundários incluíram alterações metabólicas e eletrolíticas no final da cirurgia. Resultados: Dois pacientes do grupo Plasma-Lyte® e um do grupo soro fisiológico 0,9% morreram no pós-operatório e não foram incluídos para análise. A incidência de função tardia do enxerto nos grupos Plasma-Lyte® e solução salina 0,9% foi de 60,0% [intervalo de confiança de 95% (IC) 46,2–72,4] e 74,5% [IC 95% 61,1–84,4], respectivamente (p=0,140). Os valores médios (desvio padrão) do pH no pós-operatório imediato e dos níveis de cloreto sérico nos grupos Plasma-Lyte® e solução salina 0,9% foram 7,306 (0,071) e 7,273 (0,061) (p=0,013) e 99,6 (4,2) mEq.L-1 e 103,3 (5,6) mEq.L-1, respectivamente (p0,05). Conclusão: Em receptores de transplante renal de doador falecido, a incidência de função tardia do enxerto não é influenciada pelo Plasma-Lyte® ou solução salina a 0,9% utilizada para reposição de fluidos no intraoperatório.

Palavras-chave

Anestesia; Soluções cristaloides; Função retardada do enxerto; Transplante renal; Eletrólitos; Equilíbrio ácido-base

References

1 P. Schnuelle, D. Lorenz, M. Trede, F.J. Van Der Woude Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up J Am Soc Nephrol, 9 (1998), pp. 2135-2141

2 F.K. Port, R.A. Wolfe, E.A. Mauger, D.P. Berling, K. Jiang Comparison of survival probabilities for dialysis patient’s vs cadaveric renal transplant recipients JAMA, 270 (1993), pp. 1339-1343

3 M.A. Dew, G.E. Switzer, J.M. Goycoolea, et al. Does transplantation produce quality of life benefits? A quantitative analysis of the literature Transplantation, 64 (1997), pp. 1261-1273

4 A. Hart, J.M. Smith, M.A. Skeans, et al. OPTN/SRTR 2018 Annual data report: kidney Am J Transplant, 20 (suppl 1) (2020), pp. 20-130

5 Organ Transplantation in Brazil (2012 - 2019). Associação Brasileira de Transplante de Órgãos (ABTO). Brazilian Transplantation Registry. XXV(4):1-26. https://site.abto.org.br/publicacao/rbt-ingles-2019/ [accessed 23 March 2021].

6 N. Perico, D. Cattaneo, M.H. Sayegh, G. Remuzzi Delayed graft function in kidney transplantation Lancet, 364 (2004), pp. 1814-1827

7 A. Siedlecki, W. Irish, D.C. Brennan Delayed graft function in the kidney transplant Am J Transplant, 11 (2011), pp. 2279-2296

8 H.S. Nga, L.G.M. Andrade, M.M. Contti, M.F. Valiatti, M.M.D. Silva, H.M. Takase Evaluation of the 1000 renal transplants carried out at the University Hospital of the Botucatu Medical School (HCFMB) - UNESP and their evolution over the years J Bras Nefrol., 40 (2018), pp. 162-169

9 D.W. Gjertson Impact of delayed graft function and acute rejection on graft survival Transplant Proc, 34 (2002), p. 2432

10 E.S. Hirata, M.F. Baghin, R.I. Pereira, G. Alves Filho, A. Udelsmann Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study Rev Bras Anestesiol, 59 (2009), pp. 166-176

11 Q. Lai, R. Pretagostini, L. Poli, et al. Early urine output predicts graft survival after kidney transplantation Transplant Proc, 42 (2010), pp. 1090-1092

12 S. Scheingraber, M. Rehm, C. Sehmisch, U. Finsterer Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery Anesthesiology, 90 (1999), pp. 1265-1270

13 N. Hadimioglu, I. Saadawy, T. Saglam, Z. Ertug, A. Dinckan The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation Anesth Analg, 107 (2008), pp. 264-269

14 A.D. Shaw, S.M. Bagshaw, S.L. Goldstein, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte Ann Surg, 255 (2012), pp. 821-829

15 L. Weinberg, M. Li, L. Churilov, et al. Associations of fluid amount, type, and balance and acute kidney injury in patients undergoing major surgery Anaesth Intensive Care, 46 (2018), pp. 79-87

16 J. Mårtensson, R. Bellomo Does fluid management affect the occurrence of acute kidney injury? Curr Opin Anaesthesiol, 30 (2017), pp. 84-91

17 S. Wan, A. Matthew, M.A. Roberts, P. Mount Normal saline versus lower-chloride solutions for kidney transplantation Cochrane Database Syst Rev, 9 (2016), Article CD010741

18 P. Young, M. Bailey, R. Beasley, et al. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial JAMA, 314 (2015), pp. 1701-1710

19 P.Y. Olivier, F. Beloncle, V. Seegers, et al. Assessment of renal hemodynamic toxicity of fluid challenge with 0.9% NaCl compared to balanced crystalloid (PlasmaLyte®) in a rat model with severe sepsis Ann Intensive Care, 7 (2017), p. 66

20 C.Y. Wu, K.C. Chan, Y.J. Cheng, Y.C. Yeh, C.T. Chien, Research NCoMM Effects of different types of fluid resuscitation for hemorrhagic shock on splanchnic organ microcirculation and renal reactive oxygen species formation Crit Care, 19 (2015), p. 434

21 E. Potura, G. Lindner, P. Biesenbach, et al. An acetate-buffered balanced crystalloid versus 0.9% saline in patients with end-stage renal disease undergoing cadaveric renal transplantation: a prospective randomized controlled trial Anesth Analg, 120 (2015), pp. 123-129

22 C.A. Pfortmueller, G.C. Funk, C. Reiterer, et al. Normal saline versus a balanced crystalloid for goal-directed perioperative fluid therapy in major abdominal surgery: a double-blind randomised controlled study Br J Anaesth, 120 (2018), pp. 274-283

23 D. Coskun, J. Aytac, A. Aydinli, A. Bayer Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey J Hosp Infect, 60 (2005), pp. 176-179

24 E. Mujagic, W.R. Marti, M. Coslovsky, et al. Associations of hospital length of stay with surgical site infections World J Surg, 42 (2018), pp. 3888-3896

25 S.T. Gurgel, P. do Nascimento Maintaining tissue perfusion in high-risk surgical patients: a systematic review of randomized clinical trials Anesth Analg, 112 (2011), pp. 1384-1391

26 M.M. Othman, A.Z. Ismael, G.E. Hammouda The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation Anesth Analg, 110 (2010), pp. 1440-1446

27 M.H.C. Fernandes, T. Schricker, S. Magder, R. Hatzakorzian Perioperative fluid management in kidney transplantation: a black box Crit Care, 22 (2018), p. 14

28 J. Lauronen, J.P. Peräsaari, T. Saarinen, T. Jaatinen, M. Lempinen, I. Helanterä Shorter cold ischemia time in deceased donor kidney transplantation reduces the incidence of delayed graft function especially among highly sensitized patients and kidneys from older donors Transplant Proc, 52 (2020), pp. 42-49

29 W.D. Irish, J.N. Ilsley, M.A. Schnitzler, S. Feng, D.C. Brennan A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation Am J Transplant, 10 (2010), pp. 2279-2286

30 M.G. Collins, M.A. Fahim, E.M. Pascoe, et al. Study Protocol for Better Evidence for Selecting Transplant Fluids (BEST-Fluids): a pragmatic, registry-based, multi-center, double-blind, randomized controlled trial evaluating the effect of intravenous fluid therapy with Plasma-Lyte 148 versus 0.9% saline on delayed graft function in deceased donor kidney transplantation Trials, 21 (2020), p. 428
 

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