Department of Anaesthesia, National University Hospital, Singapore.
Department of Medicine, National University Hospital, Singapore.
Ann Acad Med Singap. 2023 Dec 28;52(12):679-694. doi: 10.47102/annals-acadmedsg.202367.
This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature.
A systematic search of patients aged ≥18 years who have undergone single-organ primary renal transplantations up to June 2022 in PubMed, Embase, Scopus and CINAHL Plus was performed. Primary outcome examined was postoperative renal function. Secondary outcomes assessed were mean arterial pressure at graft reperfusion, intraoperative fluid volume and other postoperative complications. Heterogeneity was tested using I² test. The study protocol was registered on PROSPERO.
A total of 2459 studies were identified. Seven eligible studies on 607 patients were included. Subgroup assessments revealed potential renal protective benefits of GDT, with patients receiving cadaveric grafts showing lower serum creatinine on postoperative days 1 and 3, and patients monitored with arterial waveform analysis devices experiencing lower incidences of postoperative haemodialysis. Overall analysis found GDT resulted in lower incidence of tissue oedema (risk ratio [RR] 0.34, 95% CI 0.15-0.78, P=0.01) and respiratory complications (RR 0.39, 95% CI 0.17-0.90, P=0.03). However, quality of data was deemed low given inclusion of non-randomised studies, presence of heterogeneities and inconsistencies in defining outcomes measures.
While no definitive conclusions can be ascertained given current limitations, this review highlights potential benefits of using GDT in renal transplantation recipients. It prompts the need for further standardised studies to address limitations discussed in this review.
本系统评价和荟萃分析调查了术中目标导向治疗（GDT）与常规液体治疗相比对肾移植受者术后结局的影响，解决了当前文献中的这一空白。
对截至 2022 年 6 月在 PubMed、Embase、Scopus 和 CINAHL Plus 中接受过单器官原发性肾移植的年龄≥18 岁的患者进行了系统搜索。主要观察指标是术后肾功能。次要观察指标为移植物再灌注时的平均动脉压、术中液体量和其他术后并发症。使用 I²检验测试异质性。研究方案已在 PROSPERO 上注册。
共确定了 2459 项研究。纳入了 7 项关于 607 名患者的合格研究。亚组评估显示 GDT 具有潜在的肾脏保护作用，接受尸肾移植的患者术后第 1 天和第 3 天的血清肌酐较低，使用动脉波形分析设备监测的患者术后血液透析的发生率较低。总体分析发现 GDT 可降低组织水肿（风险比 [RR] 0.34，95%CI 0.15-0.78，P=0.01）和呼吸并发症（RR 0.39，95%CI 0.17-0.90，P=0.03）的发生率。然而，由于纳入了非随机研究、存在异质性以及在定义结局测量方面的不一致性，数据质量被认为较低。
鉴于目前的局限性，虽然不能确定明确的结论，但本综述强调了在肾移植受者中使用 GDT 的潜在益处。它促使需要进一步进行标准化研究以解决本综述中讨论的局限性。
