Intraoperative Hemodynamic Parameters and Acute Kidney Injury After Living Donor Liver Transplantation

Abstract

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 acute kidney injury (AKI), defined by Kidney Disease Improving Global Outcomes (KDIGO) 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 min 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 min before reperfusion were independent predictors of AKI (CVP per 5 cmH2O 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). 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 optimization of these variables may decrease the risk of AKI after LDLT.