Intraoperative Normal Saline Administration and Acute Kidney Injury in Patients Undergoing Liver Transplantation: a Retrospective Cohort Study
Overview
- Phase
- Not Applicable
- Enrollment
- 1,440
- Locations
- 1
- Primary Endpoint
- Acute kidney injury
Overview
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.
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Retrospective
Eligibility Criteria
- Ages
- 20 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts 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
Arms & Interventions
Balanced group
Patients who received balanced crystalloids of lactated Ringer's solution or plasma solution during liver transplantation surgery
Intervention: Balanced crystalloid solution (Drug)
Saline group
Patients who received only normal saline during liver transplantation surgery
Intervention: Normal saline (Drug)
Outcomes
Primary Outcomes
Acute kidney injury
Time Frame: 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 Outcomes
- In-hospital mortality(the first month after admission)
- One-year mortality(one year after transplantation)
- Length of intensive care unit stay(the first month after admission)
- Length of hospital stay(the first month after admission)
- Incidence of postoperative hemodialysis(the first month after admission)
- Early allograft dysfunction(the first 7 postoperative days)
Investigators
Won Ho Kim, MD
Professor
Seoul National University Hospital