Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Transplantation. 2019 Sep;103(9):1877-1886. doi: 10.1097/TP.0000000000002584.
Acute kidney injury (AKI) after living donor liver transplantation (LDLT) is associated with increased mortality. We sought to identify associations between intraoperative hemodynamic variables and postoperative AKI.
We retrospectively reviewed 734 cases of LDLT. Intraoperative hemodynamic variables of systemic and pulmonary arterial pressure, central venous pressure (CVP), and pulmonary artery catheter-derived parameters including mixed venous oxygen saturation (SvO2), right ventricular end-diastolic volume (RVEDV), stroke volume, systemic vascular resistance, right ventricular ejection fraction, and stroke work index were collected. Propensity score matching analysis was performed between patients with (n = 265) and without (n = 265) postoperative AKI. Hemodynamic variables were compared between patients with AKI, defined by Kidney Disease Improving Global Outcomes criteria, and those without AKI in the matched sample.
The incidence of AKI was 36.1% (265/734). Baseline CVP, baseline RVEDV, and SvO2 at 5 minutes before reperfusion were significantly different between patients with and without AKI in the matched sample of 265 pairs. Multivariable logistic regression analysis revealed that baseline CVP, baseline RVEDV, and SvO2 at 5 minutes before reperfusion were independent predictors of AKI (CVP per 5 cm H2O increase: odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09-1.32; SvO2: OR, 1.45; 95% CI, 1.27-1.71; RVEDV: OR, 1.48; 95% CI, 1.24-1.78).
The elevated baseline CVP, elevated baseline RVEDV after anesthesia induction, and decreased SvO2 during anhepatic phase were associated with postoperative AKI. Prospective trials are required to evaluate whether the optimization of these variables may decrease the risk of AKI after LDLT.
活体肝移植（LDLT）后发生急性肾损伤（AKI）与死亡率增加相关。我们试图确定术中血流动力学变量与术后 AKI 之间的关系。
我们回顾性分析了 734 例 LDLT 病例。收集了全身和肺动脉压、中心静脉压（CVP）、肺动脉导管衍生参数（包括混合静脉血氧饱和度[SvO2]、右心室舒张末期容积[RVEDV]、心排量、全身血管阻力、右心室射血分数和每搏功指数）等术中血流动力学变量。对术后发生 AKI（n = 265）和未发生 AKI（n = 265）的患者进行倾向评分匹配分析。在匹配的样本中，比较 AKI 患者（根据肾脏病改善全球结局标准定义）和无 AKI 患者的血流动力学变量。
AKI 的发生率为 36.1%（265/734）。在匹配的 265 对患者中，AKI 患者和无 AKI 患者在匹配样本中，基线 CVP、基线 RVEDV 和再灌注前 5 分钟 SvO2 存在显著差异。多变量逻辑回归分析显示，基线 CVP、基线 RVEDV 和再灌注前 5 分钟 SvO2 是 AKI 的独立预测因子（CVP 每增加 5cmH2O：比值比[OR]，1.20；95%置信区间[CI]，1.09-1.32；SvO2：OR，1.45；95%CI，1.27-1.71；RVEDV：OR，1.48；95%CI，1.24-1.78）。
麻醉诱导后基线 CVP 升高、基线 RVEDV 升高以及无肝期 SvO2 降低与术后 AKI 相关。需要前瞻性试验来评估优化这些变量是否可以降低 LDLT 后 AKI 的风险。
