Abstract
Background
We aimed to compare renal function after kidney transplantation in children who were treated with higher vs. lower fluid volumes.
Methods
A retrospective analysis of 81 living-donor renal transplantation pediatric patients was performed between the years 2007 and 2018. We analyzed associations of the decrease in serum creatinine (delta creatinine) with fluid balance, central venous pressure (CVP), pulmonary congestion, mean arterial pressure (MAP), and MAP-CVP percentiles in the first 3 postoperative days. After correcting creatinine for fluid overload, we also assessed associations of these variables with the above parameters. Finally, we evaluated the association between delta creatinine and estimated glomerular filtration rate (eGFR) at 3 months follow-up.
Results
Both delta creatinine and delta-corrected creatinine were found to be associated with pulmonary congestion on the second and third postoperative days (p < 0.02). In addition, trends for positive correlations were found of delta creatinine with fluid balance/kg (p = 0.07), and of delta-corrected creatinine with fluid balance/kg and CVP (p = 0.06–0.07) on the second postoperative day. An association was also demonstrated between the accumulated fluid balance of the first 2 days and eGFR at 3 months after transplantation (p = 0.03).
Conclusions
An association was demonstrated between indices of fluid overload, >80 ml/kg, and greater improvement in renal function.
Impact
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There is no consensus regarding the optimal fluid treatment after pediatric renal transplantation.
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In our cohort, indices of fluid overload were associated with better renal function immediately after the transplantation and 3 months thereafter.
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Fluid overload after living-donor renal transplantation in children may have short- and long-term benefits on renal function.
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Acknowledgements
We thank Mrs. Pnina Lilos for the statistical analysis and Ms. Cindy Cohen for the editorial work.
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H.P.-F. designed the data collection instruments, collected data, and drafted the initial manuscript. M.D. conceptualized and designed the study and reviewed and revised the manuscript. E.N. reviewed and revised the manuscript for important intellectual content. A.W. and E.K. collected data and reviewed and revised the manuscript for important intellectual content. G.K. conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analysis, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Porn-Feldman, H., Davidovits, M., Nahum, E. et al. Fluid overload and renal function in children after living-donor renal transplantation: a single-center retrospective analysis. Pediatr Res 90, 625–631 (2021). https://doi.org/10.1038/s41390-020-01330-4
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DOI: https://doi.org/10.1038/s41390-020-01330-4
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