[Immediate renal function after kidney transplantation (author's transl)].

The postoperative course management of kidney transplant patients appears to be easier when a large efficient diuresis resumes without delay. A decreased hemodialysis rate is observed and diagnosis of rejection is easier. Immediate diuresis resumed in 180 out of 186 (97%) recipients who received a large fluid load, given under mean pulmonary arterial pressure (PAP) monitoring. The purpose of fluid load is to provide the graft with an optimal blood flow immediately after vascular clamp release. The optimal filling pressure required varies according to initial PAP value. Fluid load aims to raise PAP to reach 25 mm Hg when the initial value is below this figure whereas it merely maintains the initial value when PAP is at 25 mm Hg or above. Mean peroperative fluid load reaches 3860 ml of water with 33 g of sodium chloride, 600 ml of 20% albumin and 3 units of packed red blood cells. During the immediate postoperative course a minimal 400 ml/h urine output is aimed at. Good hemodynamic tolerance is maintained through deliberate controlled ventilation during the first six postoperative hours. Application of this protocol was associated with general improvement of kidney transplantation outcome.