甘露醇预防肝移植后急性肾损伤：一项随机对照试验。

Mannitol for prevention of acute kidney injury after liver transplantation: a randomized controlled trial.

机构信息

Department of Anesthesiology and Intensive Care and Pain Medicine, Mansoura University, Faculty of Medicine, Mansoura, Egypt.

Liver Transplantation program, Mansoura University, Gastrointestinal Surgery Center, Mansoura, Egypt.

出版信息

BMC Anesthesiol. 2022 Dec 19;22(1):393. doi: 10.1186/s12871-022-01936-7.

DOI:10.1186/s12871-022-01936-7

PMID:36536282

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9762035/

Abstract

BACKGROUND

Acute kidney injury (AKI) is a common complication after liver transplantation, which is associated with increased morbidity and mortality. Therefore, this study investigated mannitol as an oxygen-free radical scavenger and its role in the prevention of early AKI after living donor liver transplantation (LDLT).

METHODS

A total of 84 adult patients who underwent LDLT were randomly assigned to two equal groups: the M group, where patients received 1 g/kg mannitol 20%, or the S group, where patients received an equal volume of saline. The primary outcome was the incidence of early AKI, defined as a 0.3 mg/dl increase in the serum creatinine 48 h postoperatively. Laboratory assessments of the graft and creatinine were recorded until 3 months after transplantation besides the post-reperfusion syndrome and the intraoperative hemodynamic measurements.

RESULTS

The AKI incidence was comparable between groups (relative risk ratio of 1.285, 95% CI 0.598-2.759, P = 0.518). Moreover, AKI stages and serum creatinine 3 months after transplantation, P = 0.23 and P = 0.25, respectively. The incidence of the post-reperfusion syndrome was comparable in both groups, 29/39 (74.4%) and 31/41 (75.6%) in M and S groups, respectively, P = 0.897. The intraoperative hemodynamic parameters showed no significant difference between groups using the area under the curve.

CONCLUSION

The current LDLT recipient sample was insufficient to demonstrate that pre-reperfusion 1 g/kg mannitol infusion would reduce the risk of early AKI or post-reperfusion syndrome.

CLINICAL TRIAL REGISTRATION NUMBER

Pan African Clinical Trials Registry (PACTR202203622900599); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=21511 .

摘要

背景

急性肾损伤（AKI）是肝移植后的常见并发症，与发病率和死亡率增加有关。因此，本研究探讨了甘露醇作为一种氧自由基清除剂在预防活体供肝移植（LDLT）后早期 AKI 中的作用。

方法

84 例接受 LDLT 的成年患者被随机分为两组：M 组，患者接受 1 g/kg 20%甘露醇；S 组，患者接受等量生理盐水。主要结局是早期 AKI 的发生率，定义为术后 48 小时血清肌酐升高 0.3 mg/dl。除再灌注后综合征和术中血流动力学测量外，还记录移植和肌酐的实验室评估结果，直到移植后 3 个月。

结果

两组 AKI 发生率无差异（相对风险比为 1.285，95%CI 0.598-2.759，P=0.518）。此外，AKI 分期和移植后 3 个月的血清肌酐，P=0.23 和 P=0.25。两组再灌注后综合征的发生率无差异，M 组和 S 组分别为 29/39（74.4%）和 31/41（75.6%），P=0.897。术中血流动力学参数的曲线下面积无组间差异。