INTRODUCTION: With advances in surgical and medical transplantation, progressively younger children are being transplanted. There is no consensus and little evidence on the optimal intraoperative fluid volume/type and inotropic support in small recipients (<20kg). This study provides insight into the differences in intraoperative fluid and inotropic support use between small and large recipients (>20kg).

METHODS: Patients transplanted between 2014-2017 were identified from a local transplant database at the UK's largest paediatric transplant centre. Small recipients were compared to a randomly selected group of large recipients. We compared the volume of fluid required (mean percentage of dry weight), type of fluid used and inotropes required intra-operatively between the groups. Student's T-test and Fisher's test were used for analysis. Further analysis on the small recipient group assessed the impact of intraoperative management on post-operative outcomes such as length of PICU admission and dependence on inotropic support post-operatively.

RESULTS: Twenty-five small recipients (mean weight 14.9kg, SD2.7kg) were compared with twenty-five large recipients (mean weight 48.6kg, SD 21.9). Small recipients received significantly higher volumes of fluid than large recipients (mean 15.4% (SD7.5%) vs. 6.8% (SD2.4%), p<0.001) and received significantly more colloids intra-operatively (73.9% vs. 26.1%, p=0.001). Mean fluid requirement for small recipients was 154ml/kg (range 63.7-333.3ml/kg) compared with 67.5ml/kg (range 32.6-114.3ml/kg) for large recipients. 96% of small recipients required intraoperative inotropes compared with 83% of large recipients (not statistically significant, p=0.142). Mean stay on PICU for small recipients was 66.3hours (SD110.2 hours) with mean dependence on inotropic support being 24.5hours (SD 19.6 hours). Death-censored graft survival was 100% at 1 year (1 patient died from sepsis 8 months post-transplant).

DISCUSSION: This data suggests that small recipients require larger volumes of intra-operative fluid and more colloids than large recipients. It also confirms that high fluid volumes and colloids are well tolerated by this group with excellent post-operative outcomes.

CITATION INFORMATION: Liow N., Mudalige N., Melhem N., Boyle S., Kessaris N., Hume-Smith H., Marks S., Mamode N., Stojanovic J. Large Volume Intraoperative Fluid Use in Small (<20kg) Renal Recipients is Safe Am J Transplant. 2017;17 (suppl 3).

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