Transplant Dysfunction Clinical Trial
Official title:
Hemodynamic Optimization During Single Kidney Transplantation With MostcareUP
There are currently no clear recommendations on hemodynamic targets during kidney
transplantation and most anesthesiologists rely on empiric or obsolete parameters such as
CVP.
The aim of this study is to investigate hemodynamic management of these patients applying a
new generation of advanced monitoring systems such as MOSTCAREUP which can potentially
provide a clear overview of the circulatory status beat by beat and to adjust fluid therapy
in every single patient or clinical condition.
Renal transplantation is actually considered the optimal elective treatment for end stage
kidney disease.
Successful renal transplantation involves the optimization of several parameters. Previous
studies have suggested that perioperative hemodynamic factors influence immediate and
long-term graft survival.
Perioperative hemodynamic management of this kind of surgery is nowadays focused on
optimization of fluid therapy concerning both the donor and the graft and their interaction.
Postoperative graft function is not exclusively determined by donor and graft
characteristics. Several studies over the last 30 years indeed demonstrated that hemodynamic
status of the recipient during kidney transplant surgery relates to graft function and proper
management of balancing fluid plays a critical role through maintaining optimal blood volume
and so assure an adequate supply of oxygen to the tissues.
Aggressive expansion of the intravascular volume during transplantation surgery has been
recommended by most previous studies supporting the so called "liberal" approach to fluid
management suggesting that a massive intravascular volume expansion was necessary improve
renal blood flow and minimize hypoperfusion caused tissue damages. Nowadays it is clear that
adequate early graft function requires perfusion of the transplanted kidney, which may be
enhanced by expansion of the intravascular volume in the recipient. However, some studies
have reported that aggressive intraoperative volume expansion is not always warranted in
kidney transplantation and can expose patients with preexistent cardiac disease or poor
myocardial function to the risk of fluid overload, acute respiratory failure, and prolonged
ventilation. Moreover fluid overload has been demonstrated to be harmful even for graft
perfusion, microcirculation and tissue oxygen delivery.
There are currently no clear recommendations on hemodynamic targets during kidney
transplantation and most anesthesiologists rely on empiric or obsolete parameters such as
CVP.
The aim of this study is to investigate hemodynamic management of these patients applying a
new generation of advanced monitoring systems such as MOSTCAREUP which can potentially
provide a clear overview of the circulatory status beat by beat and to adjust fluid therapy
in every single patient or clinical condition.
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