Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

Pediatr Nephrol. 2023 Apr;38(4):1299-1307. doi: 10.1007/s00467-022-05690-3. Epub 2022 Aug 16.


Background: Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events.

Methods: Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included.

Results: Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not.

Conclusions: This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Fluid; Graft survival; Hypertension; Oxygen requirement; PICU; Paediatric kidney transplant; Pulmonary oedema.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Fluid Therapy / adverse effects
  • Humans
  • Kidney Transplantation* / adverse effects
  • Prospective Studies
  • United Kingdom / epidemiology