Intraoperative Intravenous Administration in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials

The effects of intraoperative intravenous (IV) fluids choices on kidney function during renal transplantation remain unclear. This meta-analysis compared the effectiveness of normal saline with that of alternative colloids and crystalloids in end-stage renal disease (ESRD) patients who underwent renal transplantation. We searched PubMed, Embase, and Cochrane Library to April 2025. Randomized control trials comparing normal saline with IV fluids were included. The primary outcome was delayed graft function. Secondary outcomes were total fluid volume, renal function, and perioperative ion change. Sixteen trials were analyzed with random-effects model. The pooled results for delayed graft function revealed that Plasma-Lyte was associated with a significantly lower incidence rate (risk ratio = 0.82, 95% confidence interval [CI] = 0.69-0.96) than normal saline. Serum creatinine levels on day 7 revealed that lactated Ringers (mean difference [MD] = -0.08, 95% CI = -0.15 to -0.01) and sodium bicarbonate (MD = -0.21, 95% CI = -0.41 to -0.01) groups had significantly lower creatinine levels than did the normal saline group. In conclusion, Plasma-Lyte led to a more favorable short-term graft function and perioperative ion status, which may be considered a practical option in ESRD patients undergoing kidney transplantation. Prospective controlled studies are warranted to corroborate these findings.