End Stage Liver DIsease, Liver Transplant; Complications, Liver Cirrhosis
Conditions
Brief summary
The investigators attempted to investigate the association of the type of crystalloid administered during liver transplantation with postoperative clinical outcomes. The investigators hypothesized that the greater amount of normal saline or half-saline administered during liver transplantation might be associated with the increased risk of acute kidney injury compared to the balanced crystalloids.
Detailed description
Liver transplantation requires a long operation time and is often associated with a significant amount of surgical bleeding. It is common for the anesthesiologist to infuse large amounts of fluid or blood products due to bleeding, hemodynamic instability, or ascites drainage. Therefore, in the anesthesia for liver transplantation, optimal management of fluid administration is necessary and the choice of the type of crystalloid may affect the prognosis or the incidence of postoperative complications of patients. The investigators attempted to investigate the association of the type of crystalloid administered during liver transplantation with postoperative clinical outcomes. The investigators hypothesized that the greater amount of normal saline or half-saline administered during liver transplantation might be associated with the increased risk of acute kidney injury compared to the balanced crystalloids.
Interventions
DRUGNormal saline
Patients received normal saline as a maintenance crystalloid during liver transplantation surgery.
Patients received balanced crystalloids such as lactated Ringer's solution or Plasma solution as a maintenance crystalloid during liver transplantation surgery.
Sponsors
Seoul National University Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Consecutive patients who underwent living or deceased donor liver transplantation at our tertiary care university hospital between 2004 and 2018
Exclusion criteria
* patients with baseline renal dysfunction of hepatorenal syndrome or chronic kidney disease * missing preoperative serum creatinine value * missing other baseline or outcome variables * patients who received retransplantation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acute kidney injury | the first 7 postoperative days | The investigators defined acute kidney injury by the KDIGO (Kidney Disease Improving Global Outcomes) criteria, which was determined according to the greatest change in serum creatinine level during the postoperative seven days (Stage 1: more than 1.5-fold; stage 2: more than 2-fold; stage 3: more than 3-fold increase of baseline or increase in SCr to ≥ 4.0 mg/dL or the initiation of renal replacement therapy). The most recent SCr level measured before surgery was collected as a baseline value. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Early allograft dysfunction | the first 7 postoperative days | One or more of the following are present within the first 7 postoperative days: total bilirubin ≥ 10 mg/dL, PT (prothrombin time):INR (international normalized ratio)≥ 1.6, or AST (aspartate aminotransferase)/ALT (alanine aminotransferase) \> 2000 IU/L |
| In-hospital mortality | the first month after admission | all-cause mortality during hospitalization |
| Incidence of postoperative hemodialysis | the first month after admission | the incidence of new-onset postoperative hemodialysis during hospitalization |
| Length of intensive care unit stay | the first month after admission | Length of intensive care unit stay after transplantation |
| Length of hospital stay | the first month after admission | Length of hospital stay after transplantation |
| One-year mortality | one year after transplantation | all-cause mortality during one year after transplantation |
Countries
South Korea
Contacts
Primary ContactJi-yoon Jung, MD
Outcome results
None listed