Effect of Preoperative Donor Hydration on Outcomes in Living Donor Renal Transplantation: A Prospective Randomised...

Living renal donors do not usually undergo preoperative hydration, which may cause subclinical graft renal injury. We planned a prospective randomised study to determine the effect of preoperative renal donor hydration on intraoperative graft parameters, neutrophil gelatinase-associated lipocalin (NGAL) levels, and other complications.

Living donor renal transplantation pairs were randomised into two groups: Group 1 donors (controls) were fasting overnight with no hydration from 11 PM to 7 AM, while Group 2 donors were fasting with preoperative hydration (2 L of intravenous Ringer's lactate) from 11 PM to 7 AM. The primary outcome parameter was positive graft ischaemia (PGI), deemed positive when at least two were present: visible graft discolouration, renal arterial spasm, reduction in urine output before and after division of ureter, and, flaccidity of the graft.

The two groups were comparable in demographic, clinical parameters including graft function. PGI was present in 7/32 (22%), with no significant differences between the groups. Mean NGAL levels were lower in Group 2 without statistical significance. There was a significant correlation between PGI and proportion of functional delayed graft function (85% versus 36%; P = 0.03), but not between of PGI and warm ischaemia time (WIT - 55.57 ± 10.86 min vs 50.32 ± 13.14; P = 0.342), cold ischaemia time (CIT - 32.14 ± 9.12 vs 26.53 ± 11.58; P = 0.204), or mean urinary NGAL (30.67 ± 1.97 ng/mL versus 28.67 ± 2.65 ng/mL; P = 0.78).

Preoperative donor hydration may decrease perioperative subclinical renal injury, but more studies with larger sample size are required.