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
ARTICLE HIGHLIGHTS
Research background

Liver transplantation (LT) has become an option in treating a wide variety of liver diseases. Patients undergoing LT are at high risk of perioperative complications and death. Recently, there has been considerable interest in perioperative fluid therapy following major surgeries. Important question is whether fluid overload is an independent risk factor for adverse outcomes after LT. Previous reports indicate that restrictive strategy of fluids in surgical patients is beneficial. The influence of fluid accumulation on morbidity and mortality after LT has not been well evaluated up to now.

Research objectives

The aim of the study was to analyze whether cumulative positive fluid balance (FB) is associated with the occurrence of adverse outcomes after LT.

Research methods

Patients were retrospectively evaluated. In the present study, most of the patients were submitted to a liberal approach of fluid administration. Accumulated fluid balance (acFB), assessed within the first 12 hours and the 4 days following surgery, was compared with major adverse outcomes after LT.

Research results

Cumulative positive FB over 4 d after LT influences the development of acute kidney injury and it is a risk factor for the requirement for dialysis. No effect on patient survival was independently related to fluid balance.

Research conclusions

Our results show that fluid overload is a marker of severity of illness.

Research perspectives

We hope that these results may contribute to the management of liver grafted patients.