Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study
Abstract Optimal fluid strategy for laparoscopic donor nephrectomy (LDN) remains unclear. LDN has been a domain for liberal fluid management to ensure graft perfusion, but this can result in adverse outcomes due to fluid overload. We compared postoperative outcome of living kidney donors according t...
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2025-01-01
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| author | Ja Eun Lee Chisong Chung Sunghae Park Kyo Won Lee Gaab Soo Kim |
| author_facet | Ja Eun Lee Chisong Chung Sunghae Park Kyo Won Lee Gaab Soo Kim |
| author_sort | Ja Eun Lee |
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| description | Abstract Optimal fluid strategy for laparoscopic donor nephrectomy (LDN) remains unclear. LDN has been a domain for liberal fluid management to ensure graft perfusion, but this can result in adverse outcomes due to fluid overload. We compared postoperative outcome of living kidney donors according to the intraoperative fluid management. Five hundred and five LDNs performed over a six-year period at a tertiary hospital were analyzed. Donors were divided into tertiles according to intraoperative crystalloid infusion rate (ml/kg/hr), and associations between the tertile and outcomes were investigated with inverse probability of treatment weighting with entropy balancing. Primary outcome was maximal rise of serum creatinine (sCr). Secondary outcomes were sCr rise meeting Acute Kidney Injury (AKI) criteria, time to reach minimal sCr, and length of hospital stay. The following covariates were used: age, sex, body weight, height, diabetes mellitus, hypertension, preoperative estimated glomerular filtration rate, operation duration, surgeon, nephrectomy side, and estimated blood loss. Median intraoperative crystalloid infusion rate was 3.5, 4.6, and 6.0 ml/kg/hr in the first, second, and third tertile, respectively (group 1, 2, and 3). Maximal rise of sCr did not differ between groups (P = 0.274). Twofold increase in sCr (equivalent to stage 2 AKI) during the first week and prolonged hospitalization were most frequent in group 1 [7.8 vs. 1.1 vs. 1.5%, P = 0.004; 7.9 vs. 3.1 vs. 0.7%, P = 0.003]. Time to reach minimal sCr was longest in group 1. No differences were found in recipient early renal function. Hypovolemia is associated with poor postoperative outcomes after LDN. Efforts to find the optimal fluid management should be continued. |
| format | Article |
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| institution | Kabale University |
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| spelling | doaj-art-7a864291a34e4943bdfee8482c8d16602025-01-26T12:31:56ZengNature PortfolioScientific Reports2045-23222025-01-0115111110.1038/s41598-025-87497-4Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort studyJa Eun Lee0Chisong Chung1Sunghae Park2Kyo Won Lee3Gaab Soo Kim4Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineAbstract Optimal fluid strategy for laparoscopic donor nephrectomy (LDN) remains unclear. LDN has been a domain for liberal fluid management to ensure graft perfusion, but this can result in adverse outcomes due to fluid overload. We compared postoperative outcome of living kidney donors according to the intraoperative fluid management. Five hundred and five LDNs performed over a six-year period at a tertiary hospital were analyzed. Donors were divided into tertiles according to intraoperative crystalloid infusion rate (ml/kg/hr), and associations between the tertile and outcomes were investigated with inverse probability of treatment weighting with entropy balancing. Primary outcome was maximal rise of serum creatinine (sCr). Secondary outcomes were sCr rise meeting Acute Kidney Injury (AKI) criteria, time to reach minimal sCr, and length of hospital stay. The following covariates were used: age, sex, body weight, height, diabetes mellitus, hypertension, preoperative estimated glomerular filtration rate, operation duration, surgeon, nephrectomy side, and estimated blood loss. Median intraoperative crystalloid infusion rate was 3.5, 4.6, and 6.0 ml/kg/hr in the first, second, and third tertile, respectively (group 1, 2, and 3). Maximal rise of sCr did not differ between groups (P = 0.274). Twofold increase in sCr (equivalent to stage 2 AKI) during the first week and prolonged hospitalization were most frequent in group 1 [7.8 vs. 1.1 vs. 1.5%, P = 0.004; 7.9 vs. 3.1 vs. 0.7%, P = 0.003]. Time to reach minimal sCr was longest in group 1. No differences were found in recipient early renal function. Hypovolemia is associated with poor postoperative outcomes after LDN. Efforts to find the optimal fluid management should be continued.https://doi.org/10.1038/s41598-025-87497-4Intraoperative fluid managementLaparoscopic donor nephrectomyLiving kidney donor safetyAcute kidney injuryEnhanced recovery after surgery |
| spellingShingle | Ja Eun Lee Chisong Chung Sunghae Park Kyo Won Lee Gaab Soo Kim Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study Scientific Reports Intraoperative fluid management Laparoscopic donor nephrectomy Living kidney donor safety Acute kidney injury Enhanced recovery after surgery |
| title | Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study |
| title_full | Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study |
| title_fullStr | Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study |
| title_full_unstemmed | Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study |
| title_short | Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study |
| title_sort | association between intraoperative fluid management and postoperative outcomes in living kidney donors a retrospective cohort study |
| topic | Intraoperative fluid management Laparoscopic donor nephrectomy Living kidney donor safety Acute kidney injury Enhanced recovery after surgery |
| url | https://doi.org/10.1038/s41598-025-87497-4 |
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