Hemodynamic Optimization During Single Kidney Transplantation With MostcareUP
Condition: Transplant Dysfunction
MeSH terms: Solitary Kidney
Study type: Interventional

Summary: 
      There are currently no clear recommendations on hemodynamic targets during kidney
      transplantation and most anesthesiologists rely on empiric or obsolete parameters such as
      CVP.

      The aim of this study is to investigate hemodynamic management of these patients applying a
      new generation of advanced monitoring systems such as MOSTCAREUP which can potentially
      provide a clear overview of the circulatory status beat by beat and to adjust fluid therapy
      in every single patient or clinical condition.
    

Detailed description: 
      Renal transplantation is actually considered the optimal elective treatment for end stage
      kidney disease.

      Successful renal transplantation involves the optimization of several parameters. Previous
      studies have suggested that perioperative hemodynamic factors influence immediate and
      long-term graft survival.

      Perioperative hemodynamic management of this kind of surgery is nowadays focused on
      optimization of fluid therapy concerning both the donor and the graft and their interaction.
      Postoperative graft function is not exclusively determined by donor and graft
      characteristics. Several studies over the last 30 years indeed demonstrated that hemodynamic
      status of the recipient during kidney transplant surgery relates to graft function and proper
      management of balancing fluid plays a critical role through maintaining optimal blood volume
      and so assure an adequate supply of oxygen to the tissues.

      Aggressive expansion of the intravascular volume during transplantation surgery has been
      recommended by most previous studies supporting the so called "liberal" approach to fluid
      management suggesting that a massive intravascular volume expansion was necessary improve
      renal blood flow and minimize hypoperfusion caused tissue damages. Nowadays it is clear that
      adequate early graft function requires perfusion of the transplanted kidney, which may be
      enhanced by expansion of the intravascular volume in the recipient. However, some studies
      have reported that aggressive intraoperative volume expansion is not always warranted in
      kidney transplantation and can expose patients with preexistent cardiac disease or poor
      myocardial function to the risk of fluid overload, acute respiratory failure, and prolonged
      ventilation. Moreover fluid overload has been demonstrated to be harmful even for graft
      perfusion, microcirculation and tissue oxygen delivery.

      There are currently no clear recommendations on hemodynamic targets during kidney
      transplantation and most anesthesiologists rely on empiric or obsolete parameters such as
      CVP.

      The aim of this study is to investigate hemodynamic management of these patients applying a
      new generation of advanced monitoring systems such as MOSTCAREUP which can potentially
      provide a clear overview of the circulatory status beat by beat and to adjust fluid therapy
      in every single patient or clinical condition.
    

Intervention name(s): Fluid replacement based on MOSTCARE up
Intervention type(s): Device
Intervention description(s): Clinician will be able to read MOSTCARE parameters and to choose the best treatment to adequate hemodynamics considering that current literature suggests a fluid IV expansion only if PPV > 12%
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Adult patients with end stage kidney disease undergoing single kidney transplantation from deceased donor. Two arms. One arm will undergo fluid replacement based on mostcare UP information, other arm will undergo fluid replacement based on clinician experience.
Masking: None (Open Label)
Primary purpose: Other
Keywords: Transplantation, Fluid Balance