Selection of intraoperative fluid for kidney transplantation

The kidney, the most frequently transplanted organ, represents the optimal treatment for end-stage renal disease. Transplanted kidneys are highly vulnerable to perioperative injuries such as hypotension and hypovolemia, which can be influenced by perioperative fluid management. Postoperatively, delayed graft function increases the risk of graft failure. Although adequate volume administration can reduce delayed graft function, the type of intraoperative fluid most likely to benefit and support graft function remains unclear. Traditionally, crystalloids have been the primary choice for fluid management during kidney transplantation. Among these, 0.9% sodium chloride is the most commonly used, as its potassium-free composition minimizes the risk of hyperkalemia in patients with end-stage renal disease. Albumin is not routinely used, whereas synthetic colloids are discouraged owing to their nephrotoxicity. To date, 0.9% sodium chloride has demonstrated fewer advantages compared with balanced crystalloids, particularly regarding acid-base homeostasis, electrolyte balance, and delayed graft function. This review aims to examine the existing evidence on the effect of crystalloids and colloids on postoperative graft function and to recommend an appropriate fluid regimen, including balanced crystalloids, for kidney transplantation.