MAXIMAL HYDRATION DURING ANESTHESIA INCREASES PULMONARY ARTERIAL PRESSURES AND IMPROVES EARLY FUNCTION OF HUMAN RENAL TRANSPLANTS

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Abstract
The recipient''s hemodynamic condition during anesthesia for renal transplantation has a major influence on the early diuresis of the graft. The effect of maximal hydration during operation was studied in a series of 120 primary human cadaver kidney transplantations performed under preoperative monitoring of the pulmonary arterial pressures (PAP). The PAP levels before and at the time of clamp release were correlated with the frequency of postoperative acute tubular necrosis (ATN). The 120 patients were divided in 2 groups according to the PAP levels before release of the vascular clamps: group 1 (22 patients) with a mean PAP .**GRAPHIC**. of .ltoreq. 20 mm Hg and a diastolic PAP (DPAP) of .ltoreq. 15 mm Hg was compared with group 2 (98 patients) with a PAP of > 20 mm Hg and a DPAP of > 15 mm Hg. Both groups were comparable with regard to the donor''s data and the quantity of preoperative fluids. The frequency of ATN was 36% in group 1 vs. only 6% in group 2. This difference was attributed to the different hemodynamic conditions in both groups: at the beginning of the transplant procedure; .**GRAPHIC**. DPAP and central venous pressure (CVP) were higher in group 2; at the time of clamp release, .**GRAPHIC**. DPAP, CVP and systolic blood pressure (SBP) were also higher in group 2. The importance of the PAP levels at the time of release of vascular clamps was emphasized to avoid postoperative ATN of a kidney transplant.