Plasma-lyte solution versus saline in kidney transplantation: A systematic review and meta-analysis of randomized controlled trials

Abstract

Introduction The optimal intravenous fluid for kidney transplantation (KT) is still controversial. This meta-analysis aimed to compare the efficacy and safety of plasma-lyte solution (PL) versus saline (NS) in kidney transplantation. Materials and methods A comprehensive search was conducted across four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify relevant randomized controlled trials (RCTs) comparing plasma-lyte and saline in kidney transplantation. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses of delayed graft function (DGF), creatinine levels, urine output, blood pH, bicarbonate, base excess, electrolytes, serum chloride, potassium and sodium immediately post-surgery were performed. Results Totally six randomized controlled studies with 1197 patients were included. In comparison to the NS group, the PL group exhibited a significantly lower incidence of DGF (OR: 0.66, 95% CI: 0.51 to 0.86, P =  0.002) and reduced serum chloride (MD: -8.87, 95% CI: -13.50 to -4.25, P = 0.0002) as well as serum sodium(MD: -1.08, 95% CI: -1.54 to -0.61, P <  0.00001), while blood pH(MD: 0.05, 95% CI: 0.03 to 0.07, P <  0.00001), bicarbonate (MD: 2.09, 95% CI: 1.21 to 2.97, P = 0.005), and base excess levels (MD: 2.42, 95% CI: 0.72 to 4.11, P <  0.00001) were significantly elevated. No statistically significant differences were observed in creatinine, urine output, or potassium concentrations between two groups. Conclusions This meta-analysis compared the efficacy and safety between plasma-lyte and saline in kidney transplantation. Plasma-lyte reduced delayed graft function in kidney transplant compared to saline. Trial registration PROSPERO (CRD42024588701).