Comparative Analysis Of Volume Regimens For Homogeneity Variant Kidney Transplantation

Objectives: Compare three different volume regimens for kidney transplanta- tion by observing the effect on hemodynamics and turnover.To find a better treatment strategy for renal transplantation capacity so to provide meaningful clinical data.Methods: Retrospectively analysis of 1051 patients undergoing kidney transplantation from October 1997 to November 2007 in the General Hospital of Shenyang Militery Command. A total of 255 patients met standard, ASA physical statusⅡ～Ⅲ, 65.5% were men, aged 16~67 years old, weighted 31~95kg.All the patients were divided into three groups according to the kind of fluid in operation. Group A: colloids(crystalloids + succinylated gelatin + RBC + albumin); Group B: crystalloids and Red Blood Cells; Group C: crystalloids.Analysis data include:1. Baseline clinical characteristics. 2. Periopera- tive values:⑴.Hemodynamic:The systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the heart rate (HR) were recorded at following times(T0:before anesthesia, T1:the operation begin; T2:the renal artery occluded; T3:10 min after the renal artery occluded; T4:the transplantation kidney reperfused; T5:10 min after the transplantation kidney reperfused; T6: the end of surgery.⑵.The volume of infusion and losing in operation and the time of uropoiesis. Infusion volume include the volume before circlulation occluded, the volume before circulation blocked and the volume after circulation opened. And the volume of different liquids were recorded. Losing volume include the volume of urine and blood loss.⑶.Intraoperative use of dopamine and the usage frequency.⑷.Complication: The rate of cardiac failure and lung edema.⑸.The urine output were recorded at 24h, 48h, 72h and 7d after the operation.⑹.Laboratory values:①Blood analysis: Hb, Hct before and 24h after operation.②Electrolyte: preoperative and postoper- ative concentration of K+, Na+, CL- .③Kidney function: BUN and Cr were recorded at preoperative and 24h, 48h, 72h, 7d after the operation.④Urinalysis: The date of urine protein and urine specific gravity were recorded in preoperative and postoperative. 3. The data of follow-up visit, such as ICU stay, sutures out time,postoperative hospital stay, aid-dialysis rate and 1-year patient/graft survival rate.Statistical analysis: All date are reported as mean with standard devia- tion ( x±s). Test of homogeneity of variances was analyzed firstly, differences between the three groups were analyzed using the 1-way analysis of variance. Proportion and rate were expressed as present and compared with Chi-square. Date analysis was performed using SPSS for Windows (Version 13.0, SPSS Ins.)Results:1. No significant difference was found among demographic data and length of surgery.2. Haemodynamic parameters:SBP did not show statisticslly significant difference among the three groups (P>0.05). Group A's DBP was remarkably lower than the Group C at T0 and T1 (P<0.05). Among the three groups HR is no significant difference before T4, but Group C higher than Group A and Group B at T5-6(P<0.05).3. Intraoperative fluid access and urine output time The volume before circle occluded: No significant difference Among the three groups (P>0.05). The volume of circle occluded to open: Group A more than the Group B (P<0.05) and Group C (P<0.01). The volume before open the cycle: Group A of more than the volume of liquid into the Group B (P<0.05) and Group C (P<0.01). Group B, C have no significant difference. Amount of total infusion: Group A was significantly more than Group B, C (P<0.01), Group B was significantly more than Group C (P<0.01). To the volume of 0.9%NaCl: Group A was significantly smaller than the Group B and Group C (P<0.01), Group B was significantly less than the Group C (P<0.01). To the volume of equilibrium liquid: Group A was significantly greater than the Group B and Group C (P<0.01), Group B was significantly greater than the Group C (P<0.01). The volume of RBC: Group A was significantly greater than the Group B (P<0.01). Blood loss: Group A was significantly more than Group B, C (P<0.01), Group B, C has no significant difference. Urine output: among the three groups no significant difference (P>0.05). To urine time: Group A was significantly longer than the Group B and Group C (P<0.01).4. Adjuvant drug: The amount of dopamine: Group C was significantly more than the group A and group B (P<0.05). The use ratio of dopamine has no significant difference among the three groups (P>0.05).5. Urine output: Group B is significantly more than the others group during 48h after operation (P<0.05) and 72h after operation Group B is more than Group C (P<0.05).6. The variance of blood analysis and electrolyte. Hb: Before operation Group A was less than Group B, C (P<0.05), Group B was remarkably less than Group C (P<0.05).After operation Group A was less than Group B and Group C (P<0.05). Hct: Group A was less than Group B and Group C before operation (P<0.05), and 24h after the end of surgery Group A was still less than Group B (P<0.05). Electrolyte: Before operation no significant difference was found among the three groups.24h after operation, Na+ of Group C is significantly more than Group A and Group B (P<0.05). Cl- of Group A is lower than Group B and Group C (P<0.05).7. Complication: No statistically differences were found for the rate of cardiac failure and lung edema among the three groups in or after operation (P>0.05).8. Renal function: No statistically differences were found for the renal function (BUN, Cr) among the three groups before operation. 48h~7d after operation, BUN and Cr of Group B was lower than Group C (P<0.05). 72h after operation, BUN and Cr of Group A was lower than Group B (P<0.05).9. Urinalysis: No statistically differences were found for PRO and SG among the three groups preoperative and postoperative (P>0.05).10. Postoperative flow up: ICU stay time of Group A is significantly longer than Group B (P<0.05). Postoperative hospital stay of Group A and Group C are remarkably longer than Group B (P<0.05). No statistically differences were found for aid-dialysis rate and 1-year patient/graft survival rate (P>0.05).Conclusions:1.Although crystalloid infusion contribute to the protection of renal function during renal transplantation, but the effect of expansion is weak and the duration of expansion is short, so it is not conducive to maintain the stable hemodynamics, and easily lead to electrolyte imbalance, postopera- tive hospital stay extended .2. The crystalloid infusion in renal transplantation should apply the equilibrium liquid mainly.3. The combination of crystalloid and colloid infusion is conducive to the hemodynamics stable, but have no advantage for protecting renal func- tion.4. Mainly to use equilibrium liquid and infuse RBC when necessary, this volume regimen can maintain hemodynamics stable, homeostasis. and profit to turnover. It may be the best volume regimen for renal transplanta- tion.