Kohli Megha, Garg Neha, Sindwani Gaurav, Tempe Deepak, Pamecha Viniyendra, Pasupuleti Samba Siva Rao
Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India.
Department of Liver Transplant and Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, Delhi, India.
Indian J Anaesth. 2021 May;65(5):383-389. doi: 10.4103/ija.IJA_1457_20. Epub 2021 May 20.
Fluid administration during liver transplant (LT) surgery is controversial. Although adverse outcomes following positive intraoperative fluid balance have been reported, studies presenting the influence of cumulative postoperative fluid balance (CFB) on complications following LT are sparse. Patients with chronic liver disease tend to receive more fluid during and after surgery due to their unique physiological disease state. The aim of this study was to evaluate the influence of 48-hour CFB on the development of acute kidney injury (AKI) and pulmonary complications on day 4 after live donor LT.
This retrospective study included 230 patients undergoing live donor LT. The effect of CFB on day 2 on AKI and pulmonary complications was analysed. Chi-square test, Fisher's exact test, samples t-test, Mann-Whitney U-test were used.
Bivariate analysis showed a lower graft vs recipient weight ratio (GRWR), sepsis ( < 0.001) and a higher 48-hour CFB after surgery significantly increased the development of AKI. For pulmonary complications, higher Model for End- stage Liver Disease-Na(MELD-Na) score, higher peak arterial lactate, higher 48-hour CFB ( = 0.016) and sepsis ( = 0.003) were found to be statistically significant. Upon multivariate analysis, CFB at 48 hours was significantly higher in patients suffering from pulmonary complications, and GRWR and sepsis were significant for AKI. For every one litre increase in CFB on day 2, the odds of pulmonary complications increased by 37%.
A more positive CFB on day 2 increased the development of pulmonary complications and lower GRWR and sepsis increased the development of AKI.
肝移植（LT）手术期间的液体输注存在争议。尽管已有报道称术中液体正平衡会导致不良后果，但关于术后累积液体平衡（CFB）对肝移植术后并发症影响的研究却很少。由于慢性肝病患者独特的生理疾病状态，他们在手术期间和术后往往会接受更多的液体。本研究的目的是评估活体肝移植术后48小时CFB对急性肾损伤（AKI）发生及术后第4天肺部并发症的影响。
这项回顾性研究纳入了230例行活体肝移植的患者。分析了术后第2天CFB对AKI和肺部并发症的影响。采用卡方检验、Fisher精确检验、样本t检验、Mann-Whitney U检验。
二元分析显示，较低的移植物与受体重量比（GRWR）、脓毒症（<0.001）以及术后较高的48小时CFB显著增加了AKI的发生。对于肺部并发症，较高的终末期肝病钠模型（MELD-Na）评分、较高的动脉血乳酸峰值、较高的48小时CFB（=0.016）和脓毒症（=0.003）在统计学上具有显著意义。多因素分析显示，发生肺部并发症的患者术后48小时CFB显著更高，而GRWR和脓毒症对AKI具有显著影响。术后第2天CFB每增加1升，肺部并发症的发生几率增加37%。
术后第2天更正向的CFB增加了肺部并发症的发生，而较低的GRWR和脓毒症增加了AKI的发生。
