• Kyung Mi Kim, Gaab Soo Kim, and Minsoo Han.
• Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan College of Medicine, Seoul, Republic of Korea.
• Singap Med J. 2022 Dec 1; 63 (12): 731739731-739.

IntroductionOptimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft function during kidney transplantation (KT). Pulse pressure variation (PPV) and stroke volume variation (SVV) - dynamic preload indexes - are robust predictors of fluid responsiveness. This study aimed to compare the accuracy of PPV and CVP against SVV in predicting fluid responsiveness in terms of cost-effectiveness after a standardised empiric volume challenge in KT patients.Methods36 patients undergoing living-donor KT were analysed. PPV, SVV, CVP and cardiac index (CI) were measured before and after fluid loading with a hydroxyethyl starch solution (7 mL/kg of ideal body weight). Patients were classified as responders (n = 12) or non-responders (n = 24) to fluid loading when CI increases were ≥10% or <10%, respectively. The ability of PPV, SVV and CVP to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) curves.ResultsSVV and CVP measured before fluid loading were correlated with changes in CI caused by fluid expansion (ρ = 0.33, P = 0.049 and ρ = -0.37, P = 0.026) in contrast to PPV (ρ = 0.14, P = 0.429). The ROC analysis showed that SVV and CVP predicted response to volume loading (area under the ROC curve = 0.781 and 0.727, respectively; P < 0.05).ConclusionUnder the conditions of our study, SVV and CVP exhibited similar performance in predicting fluid responsiveness and could inform fluid management during KT as compared with PPV.

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