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Aggressive IV Hydration Cuts Vascular Graft Thrombosis Risk After Paediatric Renal Transplant: Presented at PAS By Jill Stein BALTIMORE, Md -- May 5, 2009 -- A rigourous postoperative intravenous (IV) hydration protocol in paediatric renal transplant recipients may protect against vascular thrombosis, researchers stated here at the 2009 Pediatric Academic Societies (PAS) Annual Meeting. Mihaela A. Damian, MD, University of Illinois at Chicago, Chicago, Illinois, presented the results of a review of 90 consecutive paediatric renal transplantations (43 cadaveric related transplants [CRT] and 47 living related transplants) on May 5. Vascular graft thrombosis graft reportedly occurs in 3.5% of all paediatric renal transplants. Overall, the complication occurs in 1.8% of living related transplants and 3.2% of cadaveric related transplants (CRT). All surgeries reviewed by Dr. Damian's group were performed by the same transplant team during a recent 10-year period using the same operative techniques and standard immunosuppressant therapy. Aggressive IV hydration combined with liberal use of diuretics and vasopressors was used in all patients to maintain a urine output above 300 mL/hr during the first 3 to 5 postoperative days. Eighteen patients in this series were aged younger than 5 years and 9 were aged younger than 2 years. Pre-emptive transplants accounted for 20% of cases. The investigators found that there were no vascular thrombotic events in the 90 patients in this series. The acute tubular necrosis rate was 3.33%; 1-year patient survival was 100%; 1-year graft survival was 99.22%; and 1-year acute rejection rate was 21%. The mean net positive fluid balance was 4.03 L/m2 per patient. Patients were hospitalised for a mean of 16.78 days. Pulmonary oedema requiring prolonged mechanical ventilation or reintubation developed in 5 patients. "Although it is associated with a significant increase in hospitalisation stay, our results show that pursuing vigorous hydration is safe and may contribute to a lower postoperative risk as well as rapid onset of sustained graft functioning," Dr. Damian said. [Presentation Title: Pediatric Renal Transplant Postoperative Hydration Protocol: Protective Against Thrombosis? Abstract Number 3852.27] E-mail this page to a friend or colleague! To print, use this version