Transplant Trial Watch

Effect of post-operative goal-directed fluid therapy (GDFT) on organ function after orthotopic liver transplantation: Secondary outcome analysis of the COLT randomised control trial.

Froghi, F., et al.

International Journal of Surgery 2022; 99: 106265.

This study aims to investigate the effect of post-operative goal-directed fluid therapy (GDFT) versus standard care (SC) on organ function following orthotopic liver transplantation in patients from the cardiac-output optimisation following liver transplantation (COLT) trial.

Participants were randomised to either the GDFT group or the SC group.

60 adult patients with liver cirrhosis undergoing liver transplantation.

Cardiac function and systemic haemodynamics, liver graft function, pulmonary function, renal function and complications.

1 year

CET Conclusions
This is a well-written report of a well-conducted randomised controlled trial. The previous publication associated with this study focused on feasibility, finding no difference in the short-term complications or survival. Clinicians of the ICU and transplant teams were blinded to the group allocation, with fluid monitoring and replacement the responsibility of a trial nurse using the non-invasive FloTrac system. This latest paper concentrates on organ function, including cardiac, liver, pulmonary and renal with each defined in advance. Patients in the goal-directed group received significantly more IV fluids in the 12-hour study period than those in the standard care group. There was no significant difference between the groups in measures of cardiac, respiratory, hepatic or renal function. Despite on average 1.5 litres of additional fluid administered to patients in the goal-directed group, they did not have a higher risk of pulmonary oedema in this study, nor was there an appreciable benefit in cardiac, renal or hepatic function. It is possible that the study was too small to observe significant benefits, particularly with renal function.

Jadad score

Data analysis
Per protocol analysis

Allocation concealment

Trial registration
ISRCTN - 10329248; Research Registry (UIN researchregistry7434)

Funding source
Non-industry funded