1. Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study
- Author
-
Bernd Saugel, Joseph Rinehart, Desislava Germanova, Francois-martin Carrier, Brenton Alexander, René Adam, Daniel Cherqui, Antoine Berna, Valerio Lucidi, Olivier Desebbe, Luc Van Obbergh, Philippe Van der Linden, Jean Louis Vincent, Brigitte Ickx, Alexandre Joosten, and Jacques Duranteau
- Subjects
Male ,Kidney Disease ,Medical Physiology ,Hemodynamics ,Transplant ,Cardiovascular ,Cohort Studies ,0302 clinical medicine ,030202 anesthesiology ,Risk Factors ,Anesthesiology ,Acute kidney disease ,Chronic kidney disease ,Intraoperative Complications ,Intraoperative ,Liver Disease ,Confounding ,Acute kidney injury ,Middle Aged ,Acute Kidney Injury ,Anesthesia ,Female ,Hypotension ,6.4 Surgery ,Research Article ,medicine.medical_specialty ,Mean arterial pressure ,Renal failure ,Renal and urogenital ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,Postoperative complications ,medicine ,Humans ,Hemodynamic ,Transplantation ,business.industry ,Evaluation of treatments and therapeutic interventions ,030208 emergency & critical care medicine ,Perioperative ,Odds ratio ,medicine.disease ,Liver Transplantation ,Anesthesiology and Pain Medicine ,Good Health and Well Being ,lcsh:Anesthesiology ,business ,Digestive Diseases ,Kidney disease - Abstract
Background Acute kidney injury (AKI) occurs frequently after liver transplant surgery and is associated with significant morbidity and mortality. While the impact of intraoperative hypotension (IOH) on postoperative AKI has been well demonstrated in patients undergoing a wide variety of non-cardiac surgeries, it remains poorly studied in liver transplant surgery. We tested the hypothesis that IOH is associated with AKI following liver transplant surgery. Methods This historical cohort study included all patients who underwent liver transplant surgery between 2014 and 2019 except those with a preoperative creatinine > 1.5 mg/dl and/or who had combined transplantation surgery. IOH was defined as any mean arterial pressure (MAP) “short” (Quartile 1, intermediate” (Quartiles 2–3, 8.6–39.5%) and “long” (Quartile 4, > 39.5%) duration. AKI stages were classified according to a “modified” “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Logistic regression modelling was conducted to assess the association between IOH and postoperative AKI. The model was run both as a univariate and with multiple perioperative covariates to test for robustness to confounders. Results Of the 205 patients who met our inclusion criteria, 117 (57.1%) developed AKI. Fifty-two (25%), 102 (50%) and 51 (25%) patients had short, intermediate and long duration of IOH respectively. In multivariate analysis, IOH was independently associated with an increased risk of AKI (adjusted odds ratio [OR] 1.05; 95%CI 1.02–1.09; P short duration” of IOH, “intermediate duration” was associated with a 10-fold increased risk of developing AKI (OR 9.7; 95%CI 4.1–22.7; P Long duration” was associated with an even greater risk of AKI compared to “short duration” (OR 34.6; 95%CI 11.5-108.6; P Conclusions Intraoperative hypotension is independently associated with the development of AKI after liver transplant surgery. The longer the MAP is
- Published
- 2021