scholarly journals Excessive Positive Fluid Balance Has A Negative Effect On Short-Term Renal Outcomes After Kidney Transplantation

2021 ◽  
Author(s):  
Jun Gyo Gwon ◽  
Cheol Woong Jung ◽  
Chang Hun Lee ◽  
Myung-Gyu Kim
Keyword(s):  
Kidney Transplantation ◽  
Old Age ◽  
Fluid Balance ◽  
Fluid Management ◽  
Management Strategies ◽  
Graft Function ◽  
High Body Mass Index ◽  
Positive Fluid Balance ◽  
Renal Outcomes ◽  
Allograft Function

Abstract Background: Optimized postoperative fluid management is important for maintaining early allograft function after kidney transplantation (KT). However, there is still no clear guidance regarding fluid treatment after KT. In this study, we investigated the effect of perioperative fluid balance on postoperative allograft function.Methods: Recipients who underwent KT between March 2012 and August 2018 were included, and their medical records were reviewed retrospectively. We calculated fluid balance, which is the difference between total input and output during the 3 days after KT, and analyzed the change in estimated glomerular filtration rate (eGFR) according to fluid balance.Results: A total of 178 patients were included after excluding those with delayed graft function or urine output <2000 ml on the first day after KT. Among them, 116 received kidneys from living donors and 62 received kidneys from deceased donors. The total fluid balance up to day 3 was 4,236.9 ± 2830.4 ml. Old age, high body mass index (BMI), excessive positive fluid balance of the recipient, and high final creatinine of the donor were significantly associated with low eGFR at 1 week. In addition, old age, BMI, and fluid balance of the recipient predicted the 1-month eGFR. In multivariate analysis, an excessive positive fluid balance was an independent predictor of low 1-week eGFR (p=0.031). Conclusions: This study demonstrated that excessive positive fluid balance can negatively affect early graft function after KT. Proper fluid management strategies based on volume conditions may provide important therapeutic opportunities to improve early renal outcomes after KT.

Perioperative Fluid Management in Kidney Transplantation: Is Volume Overload Still Mandatory for Graft Function?

2006 ◽  
Vol 38 (3) ◽  
pp. 807-809 ◽  
Author(s):  
A. De Gasperi ◽  
S. Narcisi ◽  
E. Mazza ◽  
L. Bettinelli ◽  
M. Pavani ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Fluid Management ◽  
Graft Function ◽  
Volume Overload ◽  
Perioperative Fluid Management

The dose - response association between fluid overload and hospital mortality in critically ill patients: a multicenter, prospective, observational cohort study

2020 ◽  
Author(s):  
Meiping Wang ◽  
Bo Zhu ◽  
Li Jiang ◽  
Ying Wen ◽  
Bin Du ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Dose Response ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Fluid Overload ◽  
Fluid Management ◽  
Management Strategies ◽  
Icu Admission ◽  
Increased Risk

Abstract Background Fluid management is important for ensuring hemodynamic stability in critically ill patients but easily leads to fluid overload. However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose-response relationship between fluid overload (FO) and hospital mortality in critically ill patients.Methods Data were derived from the China Critical Care Sepsis Trial (CCCST). Patients with sequential fluid data for the first 3 days of admission to the ICU were included. FO was expressed as the ratio of the cumulative fluid balance (L) and initial body weight (kg) at ICU admission as a percentage. Maximum fluid overload (MFO) was defined as the peak FO value during the first 3 days of ICU admission. We used logistic regression models with restricted cubic splines to assess the relationship between MFO and the risk of hospital mortality.ResultsIn total, 3850 patients were included, 929 (24.1%) of whom died in hospital. For each 1% L/kg increase in the FO, the risk of hospital mortality increased by 4% (HR 1.04, 95% CI 1.03 - 1.05, P < 0.001). FO greater than 10% was associated with a 44% increased HR of hospital mortality compared with FO less than 5% (HR 1.44, 95% CI 1.27 - 1.67). Notably, we also found a non-linear dose-response association between MFO and hospital mortality.Conclusions Both higher and lower fluid balance were associated with an increased risk of hospital mortality. Further studies should explore this relationship and seek for the optimal fluid management strategies for critically ill patients.

scholarly journals Synergistic impact of pre-sensitization and delayed graft function on allograft rejection in deceased donor kidney transplantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hanbi Lee ◽  
Yohan Park ◽  
Tae Hyun Ban ◽  
Sang Heon Song ◽  
Seung Hwan Song ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Allograft Rejection ◽  
Patient Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Allograft Function ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

AbstractThe aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization have synergistic adverse effects on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort. The study included 1359 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant [non-pre-sensitized-DGF(−) (n = 1097), non-pre-sensitized-DGF(+) (n = 127), pre-sensitized-DGF(−) (n = 116), and pre-sensitized-DGF(+) (n = 19)]. We compared the incidence of biopsy-proven allograft rejection (BPAR), time-related change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups. The incidence of acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable cox regression analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for the development of acute ABMR (hazard ratio 4.855, 95% confidence interval 1.499–15.727). Moreover, DGF and pre-sensitization showed significant interaction (p-value for interaction = 0.008). Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival. In conclusion, the combination of pre-sensitization and DGF showed significant synergistic interaction on the development of allograft rejection after DDKT.

scholarly journals Combined Impact of Pre-sensitization and Delayed Graft Function on Allograft Rejection in Deceased Donor Kidney Transplantation: Nationwide Cohort Study

2021 ◽  
Author(s):  
Hanbi Lee ◽  
Yohan Park ◽  
Tae Hyun Ban ◽  
Sang Heon Song ◽  
Seung Hwan Song ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Allograft Rejection ◽  
Patient Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Allograft Function ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Abstract The aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization has a synergistic adverse effect on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort. The study included 1,370 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant (non-pre-sensitized-DGF(-)(n=1100), non-pre-sensitized-DGF(+)(n=133), pre-sensitized-DGF(-)(n=116), and pre-sensitized-DGF(+)(n=21)). We compared the incidence of biopsy-proven allograft rejection (BPAR), time-related change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups. The incidence of overall BPAR and acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable cox regression analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for both overall BPAR (hazard ratio 3.253, p = 0.005) and acute ABMR (hazard ratio 7.589, p < 0.001). Moreover, DGF and pre-sensitization showed significant interaction. Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival. In conclusion, pre-sensitization and DGF had a synergistic adverse impact on allograft rejection after DDKT.

scholarly journals Characteristics of B-lymphocyte subpopulations in renal transplant recipients

2021 ◽  
Vol 13 (2) ◽  
pp. 141-150
Author(s):  
S. V. Zybleva ◽  
S. L. Zyblev
Keyword(s):  
Kidney Transplantation ◽  
B Lymphocytes ◽  
B Lymphocyte ◽  
Graft Function ◽  
Lymphocyte Subpopulations ◽  
Cell Subpopulation ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Graft Dysfunction ◽  
Allograft Function

Introduction. The presence of multiple subsets of B-cells with specific regulatory functions capable of modulating inflammatory responses havebeen detected. Most of the studies of Bregs function were carried out in the context of autoimmune and infectious diseases, whereas the objective of this research was to study the characteristics of the main, activated and tolerogenic subpopulations of B lymphocytes in patients who underwent kidney transplantation. Objective. To study the indices of B-lymphocyte subpopulations and determine their role in the development of immunological tolerance after kidney transplantation.Material and methods. We have examined 197 recipients who underwent kidney transplantation. We determined B lymphocyte subpopulation levels (CD19+IgD+CD27+ and CD19+IgD-CD27+) before transplantation, on the 1st, 3rd, 7th and 30th days after the transplantation. Allograft function was assessed on day 7 with the division of patients into two groups: with primary graft function and graft dysfunction.Results and discussion. Significant differences were revealed between the groups of recipients over three months in the following cell subpopulation levels CD19+IgD+CD27+ and CD19+IgD-CD27+. During the first 7 days, lower levels of these subpopulations were associated with satisfactory allograft function. However, by the 90th day after surgery, an increase in CD19+IgD+CD27+ B lymphocytes was noted in the group of patients with graft dysfunction.Conclusions. Low levels of not-switched (CD19+IgD+CD27+) and switched (CD19+IgD-CD27+) memory В lymphocytes in the peripheral blood of kidney transplant recipients are associated with a favorable postoperative course. We have found that on the 3rd post-transplant day, the relative level of non-switched memory B lymphocytes (CD19+IgD+CD27+) exceeding or equal to 11.47%, and the level of switched memory B lymphocytes (CD19+IgD-CD27+) exceeding or equal to 20.74% might predict the development of early renal graft dysfunction with a sensitivity and specificity of 88.40% and 84.30% for the former parameter and of 88.70% and 82.40% for the latter one, respectively.

scholarly journals Positive Fluid Balance Is Associated with Higher Mortality and Prolonged Mechanical Ventilation in Pediatric Patients with Acute Lung Injury

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Heidi R. Flori ◽  
Gwynne Church ◽  
Kathleen D. Liu ◽  
Ginny Gildengorin ◽  
Michael A. Matthay
Keyword(s):  
Mechanical Ventilation ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Fluid Balance ◽  
Pediatric Patients ◽  
Controlled Trial ◽  
Fluid Management ◽  
Secondary Outcome ◽  
Positive Fluid Balance ◽  
Organ System Failure

Introduction. We analyzed a database of 320 pediatric patients with acute lung injury (ALI), to test the hypothesis that positive fluid balance is associated with worse clinical outcomes in children with ALI.Methods. This is a post-hoc analysis of previously collected data. Cumulative fluid balance was analyzed in ml per kilogram per day for the first 72 hours after ALI while in the PICU. The primary outcome was mortality; the secondary outcome was ventilator-free days.Results. Positive fluid balance (in increments of 10 mL/kg/24 h) was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect. These relationships remained unchanged when the subgroup of patients with septic shock (n=39) were excluded.Conclusions. Persistently positive fluid balance may be deleterious to pediatric patients with ALI. A confirmatory, prospective randomized controlled trial of fluid management in pediatric patients with ALI is warranted.

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