Fluid therapy in organ transplantation

Fluid management remains a controversial subject in perioperative medicine and organ transplantation. Various case series, anecdotes and tradition guide many fluid choices, especially when good evidence is lacking. Recent advances in the understanding of pharmacokinetic and pharmodynamic profiles of fluids, as well as transplantation physiology and pathophysiology, can guide us in new approaches to common problems.

This review is intended to describe some of the latest thinking on subjects like saline-induced hyperchloraemic metabolic acidosis, the use of goal-directed approaches to volume resuscitation in perioperative medicine, the relative lack of evidence for low central venous pressure techniques in liver transplantation, some of the drug effects of intravenous fluids, as well as the complex issue of different crystalloids and colloids in renal transplantation.

Fluid therapy in transplant medicine is usually best practiced using goal-directed approaches and balanced electrolyte formulations when possible, even in renal failure. Some fluids may exert drug effects that could alter organ preservation and reperfusion, while the certain hydroxyethyl starches appear to be less toxic in renal transplantation than first suspected, especially when clinicians consider free water requirements in these settings.