Department of Anaesthesiology, Taipei City Hospital, Taipei, Taiwan; Department of Anaesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
School of Medicine, College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, Taiwan.
Br J Anaesth. 2024 Dec;133(6):1173-1182. doi: 10.1016/j.bja.2024.08.008. Epub 2024 Sep 13.
Delayed graft function after kidney transplantation is linked to poor graft survival and increased chronic allograft injury. Recent guidelines suggest using balanced crystalloids over 0.9% saline owing to better metabolic profiles, but their impact on DGF remains unclear.
We searched PubMed, Embase, and Cochrane Central Registry of Clinical Trials from inception until February 29, 2024, and included RCTs that randomised adult participants to receive either intravenous balanced fluids or 0.9% saline intraoperatively. We pooled data using a random-effects model and present risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs). We assessed individual study risk of bias using the modified Cochrane tool and certainty of evidence using GRADE. Outcomes analysed were delayed graft function incidence, vasopressor requirements, length of hospital stay, and postoperative metabolic profiles.
Of 106 publications identified, we included 11 RCTs (n=1717). Pooled analysis showed that the use of balanced fluids was associated with a lower incidence of delayed graft function compared with 0.9% saline (RR 0.82, 95% CI: 0.69 to 0.98, P=0.01, moderate certainty). Balanced crystalloids were associated with higher postoperative serum pH, higher serum bicarbonate, and lower serum chloride concentration, but effects on vasopressor requirements, length of hospital stay, and serum creatinine were uncertain.
Balanced crystalloid intravenous fluid therapy reduced delayed graft function incidence and maintained more favourable serum chemistry profiles compared with 0.9% saline in patients undergoing kidney transplantation. However, crystalloid type did not significantly influence vasopressor requirements and length of hospital stay.
肾移植后延迟移植物功能与移植物存活率降低和慢性移植物损伤增加有关。最近的指南建议使用平衡晶体液而不是 0.9%生理盐水，因为前者的代谢谱更好，但它们对 DGF 的影响仍不清楚。
我们检索了 PubMed、Embase 和 Cochrane 临床试验中心注册库，从成立到 2024 年 2 月 29 日，纳入了将成年参与者随机分配接受静脉内平衡液或 0.9%生理盐水的随机对照试验。我们使用随机效应模型汇总数据，报告风险比（RR）或均数差值，置信区间（CI）为 95%。我们使用改良 Cochrane 工具评估单个研究的偏倚风险，并使用 GRADE 评估证据的确定性。分析的结局包括延迟移植物功能的发生率、血管加压药的需求、住院时间和术后代谢谱。
在 106 篇已发表的文章中，我们纳入了 11 项 RCT（n=1717）。汇总分析显示，与 0.9%生理盐水相比，使用平衡液可降低延迟移植物功能的发生率（RR 0.82，95%CI：0.69 至 0.98，P=0.01，中等确定性）。平衡晶体液与术后血清 pH 值升高、血清碳酸氢盐升高和血清氯浓度降低有关，但对血管加压药的需求、住院时间和血清肌酐的影响不确定。
与 0.9%生理盐水相比，在接受肾移植的患者中，平衡晶体液静脉内液治疗可降低延迟移植物功能的发生率，并维持更有利的血清化学谱。然而，晶体液类型对血管加压药的需求和住院时间没有显著影响。
