Large Volume Intraoperative Fluid Use in Small (<20kg) Renal Transplant Recipients is Safe
Natasha Liow 1, Nadeesha Lakmal Mudalige1, Nabil Melhem 1, Sheila Boyle 1, Nicos Kessaris 1, Helen Hume-Smith 2, Stephen D Marks 1, Nizam Mamode 1, Jelena Stojanovic 1.
1Pediatric Nephrology , Great Ormond Street Hospital for Children NHS Foundation Trust , London, United Kingdom; 2Pediatric Anaesthesia , Great Ormond Street Hospital for Children NHS Foundation Trust , London , United Kingdom
Introduction: With advances in surgical and medical transplantation, progressively younger children are being transplanted. There is no consensus and little evidence on the optimal intraoperative fluid volume/type and inotropic support in small recipients (<20kg). This study provides insight into the differences in intraoperative fluid and inotropic support use between small and large recipients (20>kg).
Methods: Patients transplanted between 2014 and 2017 were identifed from a local transplant database at the UK's largest pediatric transplant centre. We compared the volume of fluid required (mean percentage of dry weight), type of fluid used and inotropes required intraoperatively between the groups. Student's T-test and FIsher's test were used for analysis. Further analysis on <20kg group assessed the impact of intraoperative management on post-operative outcomes such as lenght of PICU admission and dependence on inotropic support post-operatively.
Results: Twenty-five small recipients (mean weight 14.9kg, SD 2.7kg) were compared with twenty-five large recipients (mean weight 48.6kg, SD 21.9). Small recipients received significantly higher volumes of fluid than large recipients (mean 15.4% (SD 7.5%) vs 6.8% (SD 2.4%), p<0.001) and received significantly more colloids intra-operatively (70% vs 25%, p-0.003). Mean fluid requirement for small recipients was 154ml/kg (range 63.7-333.3ml/kg) compared with 67.5ml/kg (range 32.6-114.3ml/kg) for large recipients. 96% of small recipients required intraoperative inotropes compared to 83% large recipients (not statistically significant, p=0.142). Mean stay at pediatric intesive care unit for small recipients was 66.3hours (SD 110.2) with mean dependence on inotropic support being 24.5 hours (SD 19.6 hours). Death-censored graft survival was 100% at 1 year (1 patient died from sepsis eight months post transplant).
Conclusion: This data suggest that small recipients require larger volumes of intraoperative fluid and more colloids than large recipients. It also confirms that large fluid volume and colloids are well tolerated by this group with excellent post-operative outcomes.
