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. 2021 Jan 11;21(1):12.
doi: 10.1186/s12871-020-01228-y.

Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study

Alexandre Joosten  1   2 , Valerio Lucidi  3 , Brigitte Ickx  4 , Luc Van Obbergh  4 , Desislava Germanova  3 , Antoine Berna  4 , Brenton Alexander  5 , Olivier Desebbe  6 , Francois-Martin Carrier  7 , Daniel Cherqui  8 , Rene Adam  8 , Jacques Duranteau  9 , Bernd Saugel  10   11 , Jean-Louis Vincent  12 , Joseph Rinehart  13 , Philippe Van der Linden  14
Affiliations

Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study

Alexandre Joosten et al. BMC Anesthesiol. .

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) < 65 mmHg and was classified according to the percentage of case time during which the MAP was < 65 mmHg into three groups, based on the interquartile range of the study cohort: "short" (Quartile 1, < 8.6% of case time), "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 < 0.001). Compared to "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 < 0.001). "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 < 0.001).

Conclusions: Intraoperative hypotension is independently associated with the development of AKI after liver transplant surgery. The longer the MAP is < 65 mmHg, the higher the risk the patient will develop AKI in the immediate postoperative period, and the greater the likely severity. Anesthesiologists and surgeons must therefore make every effort to avoid IOH during surgery.

Keywords: Acute kidney disease; Chronic kidney disease; Hemodynamic; Intraoperative; Postoperative complications; Renal failure; Transplant.

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Conflict of interest statement

● AJ is a consultant for Edwards Lifesciences (Irvine, California, USA), Aguettant Laboratoire (Lyon, France) and Fresenius Kabi (Bad Homburg, Germany).

● BS has received honoraria for consulting, honoraria for giving lectures, and refunds of travel expenses from Edwards Lifesciences Inc. (Irvine, CA, USA). BS has received honoraria for consulting, institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from Pulsion Medical Systems SE (Feldkirchen, Germany). BS has received institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from CNSystems Medizintechnik GmbH (Graz, Austria). BS has received institutional restricted research grants from Retia Medical LLC. (Valhalla, NY, USA). BS has received honoraria for giving lectures from Philips Medizin Systeme Böblingen GmbH (Böblingen, Germany). BS has received honoraria for consulting, institutional restricted research grants, and refunds of travel expenses from Tensys Medical Inc. (San Diego, CA, USA).

● OD is consultant for Medtronic (Trévoux, FRANCE) and received honoraria for giving lectures for Medtronic (Trévoux, FRANCE) and Livanova (Châtillon, France).

● The other authors have no conflicts of interest related to this article

Figures

Fig. 1
Fig. 1
Flow chart
Fig. 2
Fig. 2
Duration of intraoperative hypotension and severity of acute kidney injury
See this image and copyright information in PMC

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