*Purpose: Patients undergoing kidney transplantation have traditionally received liberal amounts of fluid during surgery to ensure adequate fluid volume and flow to the transplanted kidney. However, excessive fluids can lead to postoperative complications such as fluid overload, ileus, or pulmonary edema. Restrictive fluid strategies in other operations have been shown to be advantageous in shorter length of stays and faster return of bowel function. In this retrospective review, we compared the effect of restrictive versus liberal fluid therapy on kidney transplantation outcomes.

*Methods: All patients who underwent deceased donor kidney transplantation at the Mayo Clinic Arizona between January 2014 and March 2019 were included in the study. Those who received less than 3 liters total intravenous fluids were considered “restrictive,” whereas those who received 3 liters and greater were considered as receiving “liberal fluid therapy.” The primary outcome was incidence of delayed graft function (DGF), which was defined as the need for dialysis within 7 days of transplant. Secondary outcomes included hospital length of stay, readmission within 30 days, return to the operating room, need for postoperative ventilation, need for intensive care unit level of care, time to return of bowel function, incidence of postoperative complications (myocardial infarction, arrhythmia, pulmonary edema, and pneumonia).

*Results: 1171 patients were included in this study; 557 in the restrictive group and 614 in the liberal group. There were no differences in demographic or baseline characteristics between the two groups. The mean fluid intake in the restrictive group was 2.12 ± 0.55 L and was 3.56 ± 0.65 L in the liberal group. There was no difference in DGF (61.9% vs. 60.3%, p=0.557), length of stay (p = 0.342), readmission (p= 0.795), return of bowel function (p=0.707), or other postoperative complications in the restrictive and liberal fluid therapy groups.

*Conclusions: Restrictive fluid therapy in deceased donor kidney transplantation was not associated with delayed graft function or worse outcomes compared to liberal fluid therapy. Restrictive fluid administration could be considered as part of enhanced recovery protocols for kidney transplantation without compromising kidney graft function.

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