[Hemodynamic changes secondary to overload infusion during cadaveric renal transplantation--comparison between...

The hemodynamic status of renal transplant patients is important for achieving early diuresis. Many reports have demonstrated that overload infusion can reduce the frequency of acute tubular necrosis (ATN). We studied the effect of overload fluid infusion using pulmonary arterial pressure (PAP) and pulmonary wedge pressure (PCWP) monitoring on forty patients undergoing cadaveric renal transplantation. Patients were divided into two groups. Group 1 received general anesthesia by nitrous oxide-isoflurane. Group 2 received continuous epidural anesthesia. Mean PAP > 15 mmHg and mean PCWP > 10 mmHg were achieved with the infusions of normosmotic saline, colloid solution and human albumin. Systolic arterial pressure (SAP) > 150 mmHg was achieved by intravenous administration of dopamine when required. Hemodynamic stability and diuresis in the early postoperative period were maintained in both groups. Group 1 required lower doses of dopamine than Group 2. Blood loss and infusion requirements were lower in group 1 than in group 2. No patient in either group developed pulmonary edema. We conclude that overload infusion using PAP and PCWP monitoring during general anesthesia can achieve safe diuresis immediately after cadaveric renal transplantation.