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World J Transplant. Jun 28, 2018; 8(3): 61-67
Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.61
Utility of central venous pressure measurement in renal transplantation: Is it evidence based?
Ahmed Aref, Tariq Zayan, Ajay Sharma, Ahmed Halawa
Ahmed Aref, Tariq Zayan, Department of Nephrology, Sur hospital, Sur 411, Sultanate of Oman
Ahmed Aref, Tariq Zayan, Ajay Sharma, Ahmed Halawa, Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
Ajay Sharma, Department of Transplantation Surgery, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
Ahmed Halawa, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
Author contributions: Aref A contributes by designing the work, data collection, and writing the manuscript; Zayan T contributes to data collection and organisation of scientific material; Sharma A reviewed and edited the manuscript; Halawa A contributes by choosing the topic of our work, providing expert opinion for writing our work and final editing of the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahmed Halawa, FRCS (Gen Surg), MD, MSc, Surgeon, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom. ahmed.halawa@sth.nhs.uk
Telephone: +44-77-87542128 Fax: +44-11-42714604
Received: December 30, 2017
Peer-review started: January 1, 2018
First decision: January 31, 2018
Revised: March 5, 2018
Accepted: April 1, 2018
Article in press: April 1, 2018
Published online: June 28, 2018
Abstract

Adequate intravenous fluid therapy is essential in renal transplant recipients to ensure a good allograft perfusion. Central venous pressure (CVP) has been considered the cornerstone to guide the fluid therapy for decades; it was the only available simple tool worldwide. However, the revolutionary advances in assessing the dynamic preload variables together with the availability of new equipment to precisely measure the effect of intravenous fluids on the cardiac output had created a question mark on the future role of CVP. Despite the critical role of fluid therapy in the field of transplantation. There are only a few clinical studies that compared the CVP guided fluid therapy with the other modern techniques and their relation to the outcome in renal transplantation. Our work sheds some light on the available published data in renal transplantation, together with data from other disciplines evaluating the utility of central venous pressure measurement. Although lager well-designed studies are still required to consolidate the role of new techniques in the field of renal transplantation, we can confidently declare that the new techniques have the advantages of providing more accurate haemodynamic assessment, which results in a better patient outcome.

Keywords: Fluid monitoring, Central venous pressure, Renal transplantation

Core tip: We suggest that central venous pressure (CVP) measurement should be abandoned in renal transplantation since it may be misleading. We recommend using intra-operative and post-operative cardiac output monitoring devices for guiding fluid therapy in renal transplant recipients. Although lager well-designed studies are still required to consolidate the role of new techniques in comparison to CVP monitoring in the field of renal transplantation. We Suggest that the new methods have the advantage of providing a more accurate haemodynamic assessment in renal transplant cases.