Goal-Directed Hemodynamic Therapy in Deceased-Donor Kidney Transplantation: A Prospective Paired-Kidney Study

To evaluate whether goal-directed hemodynamic therapy (GDHT) using uncalibrated pulse contour analysis (FloTrac) optimizes intraoperative hemodynamics, pharmacologic support, and early graft function compared with standard central venous pressure (CVP)-guided therapy in deceased-donor kidney transplantation.

A prospective, randomized, comparative study utilizing a rigorous paired-kidney design to neutralize donor-derived confounders.

A single-center, tertiary university hospital.

Forty patients with end-stage renal disease who received kidney transplants from 20 brain-dead donors (20 matched pairs).

Recipients of each donor pair were randomized to either the GDHT group (targeting stroke volume maximization with a change in stroke volume index <10% and mean arterial pressure [MAP] ≥65 mmHg) or the control group (targeting CVP 8-12 mmHg and MAP ≥80 mmHg).

Intraoperative continuous hemodynamics were analyzed via linear mixed-effects models. The GDHT group received significantly less total intravenous fluid than the control group (1,385.0 ± 259.6 v 1,958.0 ± 877.0 mL, p = 0.011). While mean arterial pressure remained equivalent (p = 0.914), the GDHT cohort achieved higher early stroke volume index at 15 minutes postinduction (p = 0.033) and maintained lower CVP levels throughout surgery (p = 0.002). Notably, the GDHT protocol markedly reduced reliance on rescue vasopressors (45.0% v 100%, p = 0.001). Postoperative serum creatinine trajectories and delayed graft function rates (10%) were identical between cohorts.

FloTrac-guided GDHT safely restricts intraoperative fluid administration and optimizes early systemic flow. Avoiding unnecessary volume expansion mitigates iatrogenic vasoplegia and reduces rescue vasopressor requirements, while facilitating excellent early allograft recovery.