The effect of goal-directed fluid therapy in renal transplant surgery on postoperative outcome: A retrospective study

Background: This study aimed to compare the effects of intraoperative conventional fluid therapy using central venous pressure guidance and goal-directed fluid therapy using stroke volume variation guidance on the incidence of delayed graft function in renal transplant surgery. Materials and Methods: We retrospectively analyzed 179 patients who underwent renal transplant surgery at a single tertiary hospital. Patients were categorized into conventional fluid therapy and goal-directed fluid therapy groups. Patients in the conventional fluid therapy group were managed based on a target central venous pressure of 8–12 mm Hg, while patients in the goal-directed fluid therapy group were managed by targeting a stroke volume variation of 10% within the preoperative baseline, apart from the target mean arterial pressure >80 mm Hg in both groups. Preoperative characteristics and intraoperative parameters were evaluated to determine their association with postoperative outcomes. Results: The goal-directed fluid therapy group demonstrated a significant reduction in the incidence of postoperative delayed graft function ( P = 0.007), metabolic acidosis ( P < 0.001), cardiorespiratory complications ( P = 0.011), ventilator dependency ( P = 0.013), and length of intensive care unit ( P < 0.001) and hospital stays ( P < 0.001). Multiple logistic regression analysis revealed that receiving a graft from a deceased donor increased the odds of developing delayed graft function by 4.07 times compared with a living donor. In contrast, patients managed with goal-directed fluid therapy had a 72% lower risk of developing delayed graft function and were 9.17 times more likely to achieve 28-day graft function compared with those in the conventional fluid therapy group. Conclusions: Goal-directed fluid therapy reduced the incidence of delayed graft function, metabolic acidosis, cardiorespiratory complications, and ventilator dependency and shortened intensive care unit and hospital stays in renal transplant surgery.