Perioperative fluid management in kidney transplantation: What’s new and future directives?

Table 1 Different types of perioperative fluids in kidney transplantation

Type of fluid	Pros	Cons
Normal saline	Less expensive, easily available, potassium free	Potentially hypertonic, Risk of hyperchloremic metabolic acidosis, hyperkalemia, decreased GFR and urine output, AKI, and DGF large volume infusion should be avoided
Low chloride solutions (e.g., Kabilyte, Plasm-Lyte A)	Physiologically like plasma, no risk of hyperkalemia, metabolic acidosis, and DGF. Fluid of choice during kidney transplant	More expensive than other crystalloids
Ringer lactate	Balanced crystalloid, isotonic, has buffering capacity, is cost-effective, and safe	Theoretical risk of lactic acidosis and hyperkalemia
Hydroxyethyl starch	Volume expander, easily available	Risk of AKI, renal replacement therapy, and coagulopathy
Albumin	Increases plasma oncotic pressure, antioxidant properties, immunomodulation, protection from ischemia-reperfusion injury, less requirement of crystalloids, and vasopressors	Increased cost, risk of allergic reactions, and disease transmission. No benefit or increased risk of volume-related complications in recipients with cardio-pulmonary compromise. Routine use is not recommended

GFR: Glomerular filtration rate; AKI: Acute kidney injury; DGF: Delayed graft function.