Early hemodynamic changes after renal transplantation: determinants of low central venous pressure in the recipients and correlation with acute renal dysfunction.

BACKGROUND: Transplantation of organs leads to several physiologic changes in the recipients who, during their anephric state on chronic hemodialysis, have increased total body water and several electrolyte imbalances. Several abnormal parameters are observed in the physiology of the renal recipient. The central venous pressure (CVP) in the recipient invariably declines despite vigorous fluid resuscitation for reasons that are not clear at the present time. MATERIAL/METHODS: We studied 77 kidney transplants retrospectively, in which we observed a significant decline in central venous pressure (CVP) in the immediate posttransplant period. This phenomenon occurred despite aggressive fluid management and positive fluid balances averaging nearly four liters. Our analysis included the time course of the phenomenon itself as well as a detailed comparison of various parameters in the recipient and the renal graft for possible correlation with this consistent decline in CVP. RESULTS: Neither the absolute CVP nor the drop in CVP appeared to influence the rate of ATN. Interestingly, we found that the kinetics of the decline in CVP were remarkably similar in recipients of both cadaveric and living-related kidneys. CONCLUSIONS: This finding suggests that the reperfusion injury or a related effect may be responsible for the clinical phenomenon presented in this study.