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Venovenous Bypass Is Associated With a Lower Incidence of Acute Kidney Injury After Liver Transplantation in Patients With Compromised Pretransplant Renal Function

Sun, Kai MD*†; Hong, Fu MD; Wang, Yun BS; Agopian, Vatche G. MD; Yan, Min MD*; Busuttil, Ronald W. MD, PhD; Steadman, Randolph H. MD; Xia, Victor W. MD

doi: 10.1213/ANE.0000000000002311
Cardiovascular Anesthesiology: Original Clinical Research Report

BACKGROUND: Although the hemodynamic benefits of venovenous bypass (VVB) during liver transplantation (LT) are well appreciated, the impact of VVB on posttransplant renal function is uncertain. The aim of this study was to determine if VVB was associated with a lower incidence of posttransplant acute kidney injury (AKI).

METHODS: Medical records of adult (≥18 years) patients who underwent primary LT between 2004 and 2014 at a tertiary hospital were reviewed. Patients who required pretransplant renal replacement therapy and intraoperative piggyback technique were excluded. Patients were divided into 2 groups, VVB and non-VVB. AKI, determined by the Acute Kidney Injury Network criteria, was compared between the 2 groups. Propensity match was used to control selection bias that occurred before VVB and multivariable logistic regression was used to control confounding factors during and after VVB.

RESULTS: Of 1037 adult patients who met the study inclusion criteria, 247 (23.8%) received VVB. A total of 442 patients (221 patients in each group) were matched. Aftermatch patients were further divided according to a predicted probability AKI model using preoperative creatinine (Cr), VVB, and intraoperative variables into 2 subgroups: normal and compromised pretransplant renal functions. In patients with compromised pretransplant renal function (Cr ≥1.2 mg/dL), the incidence of AKI was significantly lower in the VVB group compared with the non-VVB group (37.2% vs 50.8%; P = .033). VVB was an independent risk factor negatively associated with AKI (odds ratio, 0.1; 95% confidence interval, 0.1–0.4; P = .001). Renal replacement in 30 days and 1-year recipient mortality were not significantly different between the 2 groups. The incidence of posttransplant AKI was not significantly different between the 2 groups in patients with normal pretransplant renal function (Cr <1.2 mg/dL).

CONCLUSIONS: In this large retrospective study, we demonstrated that utilization of intraoperative VVB was associated with a significantly lower incidence of posttransplant AKI in patients with compromised pretransplant renal function. Further studies to assess the role of intraoperative VVB in posttransplant AKI are warranted.

Supplemental Digital Content is available in the text.Published ahead of print July 21, 2017.

From the *Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; and Department of Anesthesiology and Perioperative Medicine and Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.

Accepted for publication May 16, 2017.

Published ahead of print July 21, 2017.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Study: The impact of venovenous bypass on perioperative outcomes in liver transplantation. Approved by Alison Moore, MPH, MD, Chair, South General Institutional Review Board, 11000 Kinross Ave, Suite 211, Los Angeles, CA 90095.

Institutional review board information: IRB#15-000343 University of California, Los Angeles, CA.

Reprints will not be available from the authors.

Address correspondence to Victor W. Xia, MD, Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095. Address e-mail to

© 2017 International Anesthesia Research Society
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