The scientific literature provides little evidence-based guidance in amount (quantitative fluid intervention) or type (qualitative fluid intervention) of fluid to optimize outcomes during liver and renal transplantation. Fluid intervention and vasoactive pharmacological support for transplantation depend on clinician preference, institutional resources and practice culture. Patients undergoing liver and renal transplantation should be managed on an individualized basis. No single approach will be effective. This chapter provides a contemporary overview of the fundamental principles underpinning fluid intervention for adult liver and renal transplantation. The overarching principles of fluid intervention for transplantation are to normalize the microcirculation by maintaining intravascular volume, tissue perfusion and tissue oxygenation, thereby protecting the new graft and other organs. The chapter also summarizes contemporary recommendations from expert panels for the perioperative fluid management and outcomes for adults undergoing liver and kidney transplantation.

The aim of hemodynamic monitoring is to enable the optimization of cardiac output and therefore improve oxygen delivery to the tissues, avoiding the accumulation of oxygen debt, in the perioperative period. Instigating goal-directed therapy based on validated optimization algorithms has been shown to reduce mortality in high-risk patients and complications in moderate- to high-risk patients.

A number of devices are available to facilitate this goal. Devices that continuously analyze the arterial pressure waveform to calculate various flow parameters have been developed and validated. These devices have facilitated the introduction of hemodynamic monitoring to the wider surgical population, providing useful clinical information that enables the judicious use of fluid therapy whilst avoiding hypervolemia.

This chapter explores the role that hemodynamic optimization plays in perioperative care, describes some of the commonly used invasive hemodynamic monitors, and explains how to use the information produced effectively. Used correctly, any monitor can be useful to improve outcome if applied to the right population, at the right time, and with the right strategy.