Transplant Trial Watch

Balanced Crystalloids Versus Normal Saline in Kidney Transplant Patients: An Updated Systematic Review, Meta-analysis, and Trial Sequential Analysis.

Carvalho Pereira, L., et al.

Anesthesia & Analgesia 2024 [record in progress].

This study aimed to evaluate whether low-chloride solutions would reduce the incidence of delayed graft function and improve acid-base and electrolyte balance in kidney transplant recipients.

Three electronic databases, including MEDLINE, EMBASE, and Cochrane, were searched for relevant literature. Studies were screened and data were extracted by two independent reviewers. The Cochrane Risk of Bias Tool for Randomized Trials 2 (RoB2) was used to assess the quality of the included randomised controlled trials.

12 studies were included in the review.

The primary outcome was the incidence of delayed graft function. The secondary outcomes included end of surgery chloride, bicarbonate, pH, base excess (BE) and potassium, and post-operative creatinine and urine output.


CET Conclusions
This systematic review aimed to examine whether balanced crystalloid solutions would result in better clinical outcomes in kidney transplant recipients, compared to normal saline. Twelve studies were included, all of which were randomised controlled studies. Study selection, data extraction and quality assessment were performed in duplicate. The meta-analyses revealed that the use of balanced low-chloride solutions resulted in a significant reduction in the incidence of delayed graft function (DGF), and improved acid-base and electrolyte control in kidney transplant patients, leading the authors to conclude that balanced lower-chloride solutions can be used as a safe alternative to normal saline and may even lead to better post-transplant outcomes. It is important to note that while the difference in the occurrence of delayed graft function was significant in the overall analysis that included both living and deceased donors, the subgroup analysis showed that this difference was only significant for deceased donor transplant recipients and not for living donor transplant recipients. A potential reason for this could be that only a few studies (three studies) reported DGF outcomes for living-donor transplant recipients, out of which one study had zero events for both arms. Heterogeneity was negligible for most of the primary outcomes. However, the influence of potential confounders were not accounted for in the analyses.

Trial registration
PROSPERO - CRD42023447301

Funding source
No funding received