Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 24, 2018; 8(2): 44-51
Published online Apr 24, 2018. doi: 10.5500/wjt.v8.i2.44
Cumulative positive fluid balance is a risk factor for acute kidney injury and requirement for renal replacement therapy after liver transplantation
Liana Codes, Ygor Gomes de Souza, Ricardo Azevedo Cruz D’Oliveira, Jorge Luiz Andrade Bastos, Paulo Lisboa Bittencourt
Liana Codes, Ygor Gomes de Souza, Ricardo Azevedo Cruz D’Oliveira, Paulo Lisboa Bittencourt, Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia 40140-901, Brazil
Jorge Luiz Andrade Bastos, Medical School of Bahia, Federal University of Bahia, Bahia 40110-100, Brazil
Author contributions: Codes L, de Souza YG and Bittencourt PL contributed to study conception and design, and writing of article; Codes L, de Souza YG, D’Oliveira RAC, Bastos JLA contributed to data acquisition, data analysis and interpretation; Codes L, D’Oliveira RAC and Bittencourt PL contributed to editing, reviewing and final approval of article.
Institutional review board statement: This study was approved by Ethics Committee in Research at Portuguese Hospital in Bahia, Brazil (CAAE: 81125717.2.0000.5029).
Informed consent statement: The institutional review board waived informed consent due to the retrospective study design without patient contact or intervention; thus representing minimal risk study.
Conflict-of-interest statement: There are no conflicts of interest relevant to the conduct of this study.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Liana Codes, MD, PhD, Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Av. Princesa Isabel, 914, Bahia 40140-901, Brazil. liana.foulon@hportugues.com.br
Telephone: +55-71-32035375 Fax: +55-71-32033456
Received: February 19, 2018
Peer-review started: February 19, 2018
First decision: March 7, 2018
Revised: March 12, 2018
Accepted: April 1, 2018
Article in press: April 1, 2018
Published online: April 24, 2018
Processing time: 63 Days and 15.3 Hours
Abstract
AIM

To analyze whether fluid overload is an independent risk factor of adverse outcomes after liver transplantation (LT).

METHODS

One hundred and twenty-one patients submitted to LT were retrospectively evaluated. Data regarding perioperative and postoperative variables previously associated with adverse outcomes after LT were reviewed. Cumulative fluid balance (FB) in the first 12 h and 4 d after surgery were compared with major adverse outcomes after LT.

RESULTS

Most of the patients were submitted to a liberal approach of fluid administration with a mean cumulative FB over 5 L and 10 L, respectively, in the first 12 h and 4 d after LT. Cumulative FB in 4 d was independently associated with occurrence of both AKI and requirement for renal replacement therapy (RRT) (OR = 2.3; 95%CI: 1.37-3.86, P = 0.02 and OR = 2.89; 95%CI: 1.52-5.49, P = 0.001 respectively). Other variables on multivariate analysis associated with AKI and RRT were, respectively, male sex and Acute Physiology and Chronic Health Disease Classification System (APACHE II) levels and sepsis or septic shock. Mortality was shown to be independently related to AST and APACHE II levels (OR = 2.35; 95%CI: 1.1-5.05, P = 0.02 and 2.63; 95%CI: 1.0-6.87, P = 0.04 respectively), probably reflecting the degree of graft dysfunction and severity of early postoperative course of LT. No effect of FB on mortality after LT was disclosed.

CONCLUSION

Cumulative positive FB over 4 d after LT is independently associated with the development of AKI and the requirement of RRT. Survival was not independently related to FB, but to surrogate markers of graft dysfunction and severity of postoperative course of LT.

Keywords: Liver transplantation; Fluid balance; Acute kidney injury

Core tip: Whether fluid overload is an independent mediator of adverse outcomes on early postoperative liver transplantation (LT). The influence of fluid accumulation on morbidity and mortality after LT has not been well evaluated up to now. This study aims to analyze whether fluid management influences the early postoperative outcome after LT. Cumulative positive fluid balance (FB) over 4 d after LT influence the development of acute kidney injury and it is a risk factor for the requirement for renal replacement therapy. Survival is not independently related to FB but to surrogate markers of graft dysfunction.