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Intraoperative Hemodynamic Parameters and Acute Kidney Injury After Living Donor Liver Transplantation

Kim, Won Ho MD, PhD1,2; Oh, Hye-Won MD1; Yang, Seong-Mi MD1; Yu, Je Hyuk MD1; Lee, Hyung-Chul MD1; Jung, Chul-Woo MD, PhD1,2; Suh, Kyung-Suk MD, PhD3; Lee, Kook Hyun MD, PhD1,2

doi: 10.1097/TP.0000000000002584
Original Clinical Science—Liver
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Background. Acute kidney injury (AKI) after living donor liver transplantation (LDLT) is associated with increased mortality. We sought to identify associations between intraoperative hemodynamic variables and postoperative AKI.

Methods. We retrospectively reviewed 734 cases of LDLT. Intraoperative hemodynamic variables of systemic and pulmonary arterial pressure, central venous pressure (CVP), and pulmonary artery catheter–derived parameters including mixed venous oxygen saturation (SvO2), right ventricular end-diastolic volume (RVEDV), stroke volume, systemic vascular resistance, right ventricular ejection fraction, and stroke work index were collected. Propensity score matching analysis was performed between patients with (n = 265) and without (n = 265) postoperative AKI. Hemodynamic variables were compared between patients with AKI, defined by Kidney Disease Improving Global Outcomes criteria, and those without AKI in the matched sample.

Results. The incidence of AKI was 36.1% (265/734). Baseline CVP, baseline RVEDV, and SvO2 at 5 minutes before reperfusion were significantly different between patients with and without AKI in the matched sample of 265 pairs. Multivariable logistic regression analysis revealed that baseline CVP, baseline RVEDV, and SvO2 at 5 minutes before reperfusion were independent predictors of AKI (CVP per 5 cm H2O increase: odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09-1.32; SvO2: OR, 1.45; 95% CI, 1.27-1.71; RVEDV: OR, 1.48; 95% CI, 1.24-1.78).

Conclusions. The elevated baseline CVP, elevated baseline RVEDV after anesthesia induction, and decreased SvO2 during anhepatic phase were associated with postoperative AKI. Prospective trials are required to evaluate whether the optimization of these variables may decrease the risk of AKI after LDLT.

1 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

2 Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

3 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.

Received 20 June 2018. Revision received 3 December 2018.

Accepted 16 December 2018.

The authors declare no funding or conflicts of interest.

W.H.K. involved in study design, data collection, statistical analysis, and manuscript preparation. H-W.O. involved in statistical analysis and manuscript preparation. S-M.Y. involved in data collection and manuscript revision. J.H.Y. involved in data collection and manuscript revision. H-C.L. involved in data collection, statistical analysis, and manuscript revision. C-W.J., K-S.S., and K.H.L. involved in manuscript revision.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Won Ho Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. (wonhokim.ane@gmail.com).

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