Transplant Trial Watch

The effect of pulse pressure variation compared with central venous pressure on intraoperative fluid management during kidney transplant surgery: a randomized controlled trial.

Kannan, G., et al.

Canadian Journal of Anaesthesia 2021 [record in progress].


Aims
The aim of this study was to investigate whether pulse pressure variation (PPV)-guided fluid administration will lead to better optimization of intravascular fluid volume during renal transplant surgery, compared to central venous pressure (CVP)-guided strategy.

Interventions
Participants were randomised to either the PPV group or the CVP group.

Participants
77 adult patients (>18 years) undergoing kidney transplant surgery.

Outcomes
The primary endpoint was the total volume of intraoperative fluids administered at the time of renal transplant surgery. Secondary endpoints were intraoperative hemodynamic changes, need for dialysis within the first week, serum lactate levels, creatinine elimination ratio, serum creatinine, and incidence of immediate and delayed graft dysfunction.

Follow-up
1 week

CET Conclusions
This single-centre randomised controlled trial randomised 77 kidney transplant recipients to either CVP-monitored fluid therapy or pulse-pressure (PPV) monitored fluid. The PPV group received significantly less intraoperative fluid, but there was no improvement in any other secondary clinical endpoints. The protocol is well described. The study is reported to be “double blind”, but the method of blinding is not described and it is unclear how the anaesthetist could be blinded to the method of monitoring, raising concerns of potential treatment bias in the primary endpoint. Whilst there is a reduction in fluid administration with PPV, the small sample size means that it is still uncertain as to whether this translates into any real clinical benefit.

Jadad score
4

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
CTRI/2018/01/011638

Funding source
Non-industry funded