Intraoperative Normal Saline Administration and Acute Kidney Injury in Patients Undergoing Liver Transplantation
Study Details
Study Description
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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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
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Balanced group Patients who received balanced crystalloids of lactated Ringer's solution or plasma solution during liver transplantation surgery |
Drug: Balanced crystalloid solution
Patients received balanced crystalloids such as lactated Ringer's solution or Plasma solution as a maintenance crystalloid during liver transplantation surgery.
Other Names:
|
| Saline group Patients who received only normal saline during liver transplantation surgery |
Drug: Normal saline
Patients received normal saline as a maintenance crystalloid during liver transplantation surgery.
|
Outcome Measures
Primary Outcome Measures
- 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 Outcome Measures
- Incidence of postoperative hemodialysis [the first month after admission]
the incidence of new-onset postoperative hemodialysis during hospitalization
- 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
- One-year mortality [one year after transplantation]
all-cause mortality during one year after transplantation
- 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
Eligibility Criteria
Criteria
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
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missing other baseline or outcome variables
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patients who received retransplantation
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Seoul National University Hospital | Seoul | Korea, Republic of | 03080 |
Sponsors and Collaborators
- Seoul National University Hospital
Investigators
- Study Chair: Won Ho Kim, MD, PhD, Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- H-2108-173-1248