{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:45:36Z","timestamp":1780393536603,"version":"3.54.1"},"reference-count":10,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Prog Transpl"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>Introduction: Kidney transplant graft function depends on optimised haemodynamics. However, high fluid volumes risk hypervolaemic complications. The Edwards Lifesciences ClearSight\u2122 device permits fluid titration through markers of preload and beat-to-beat blood pressure monitoring. We evaluated the implementation of a novel goal-directed haemodynamic therapy protocol to determine whether patient outcomes had improved. Design: A retrospective evaluation of standard care versus goal-directed haemodynamic therapy in adults undergoing kidney transplantation was performed in a single centre between April 2016 and October 2019. Twenty-eight standard-of-care patients received intraoperative fixed-rate infusion and 28 patients received goal-directed haemodynamic therapy. The primary outcome was volume of fluid administered intraoperatively. Secondary outcomes included blood product and vasoactive drug exposure, graft and recipient outcomes. Results: Intraoperative fluid administered was significantly reduced in the goal-directed haemodynamic therapy cohort (4325 vs 2751\u2005ml, P\u2009&lt;\u2009.001). Exposure to vasopressor (67.9% vs 42.9%, P\u2009=\u2009.060) and blood products (17.9% vs 3.6%, P\u2009=\u2009.101) was unchanged. Immediate graft function (82.1% vs 75.0%, P\u2009=\u2009.515), dialysis requirement (14.3% vs 21.4%, P\u2009=\u2009.729) and creatinine changes post-operatively were unchanged. In the goal-directed haemodynamic therapy cohort, 1 patient had pulmonary oedema (3.6%) versus 21.4% in the standard cohort. Patients in the goal-directed haemodynamic therapy group were more likely to mobilise within 48 hours of surgery (number needed to treat\u2009=\u20093.5, P\u2009=\u2009.012). Conclusions: Protocolised goal-directed haemodynamic therapy in kidney transplantation was safe and may improve patient, graft, and surgical outcomes. Clinical trials assessing goal-directed approaches are needed.<\/jats:p>","DOI":"10.1177\/15269248231164165","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T03:59:21Z","timestamp":1679284761000},"page":"150-155","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Goal-Directed Haemodynamic Therapy Improves Patient Outcomes in Kidney Transplantation"],"prefix":"10.1177","volume":"33","author":[{"given":"Jez","family":"Fabes","sequence":"first","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"},{"name":"Peninsula Medical School, University of Plymouth, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Al Midani","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman S","family":"Sarna","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina H","family":"Hadi","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saqib A","family":"Naji","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal R","family":"Banga","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth L","family":"Jones","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D","family":"Berry","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-7921","authenticated-orcid":false,"given":"Marc D","family":"Wittenberg","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"bibr1-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1159\/000491558"},{"key":"bibr2-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1928-2"},{"key":"bibr3-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfz017"},{"key":"bibr4-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2010.08.042"},{"key":"bibr5-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181d82ca8"},{"key":"bibr6-15269248231164165","unstructured":"NHSBT. Annual Report on Kidney Transplantation. [online]. Accessed February 23, 2023. Available at: https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco-assets-corp\/24800\/kidney-annual-report-2020-21.pdf"},{"key":"bibr7-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15233"},{"issue":"2","key":"bibr8-15269248231164165","first-page":"127","volume":"16","author":"Halawa A","year":"2018","journal-title":"Exp Clin Transplant"},{"key":"bibr9-15269248231164165","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8010080"},{"key":"bibr10-15269248231164165","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-015-2046-4"}],"container-title":["Progress in Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15269248231164165","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15269248231164165","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15269248231164165","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:41:57Z","timestamp":1777700517000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15269248231164165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,20]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1177\/15269248231164165"],"URL":"https:\/\/doi.org\/10.1177\/15269248231164165","relation":{},"ISSN":["1526-9248","2164-6708"],"issn-type":[{"value":"1526-9248","type":"print"},{"value":"2164-6708","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,20]]}}}