Sodium Bicarbonate Infusion in Patients Undergoing Orthotopic Liver Transplantation: A Single Center Randomized Controlled Pilot Trial

Clin Transplant. 2016 May;30(5):556-65. doi: 10.1111/ctr.12721. Epub 2016 Mar 14.

Abstract

Background: Liver transplantation-associated acute kidney injury (AKI) carries significant morbidity and mortality. We hypothesized that sodium bicarbonate would reduce the incidence and/or severity of liver transplantation-associated AKI.

Methods: In this double-blinded pilot RCT, adult patients undergoing orthotopic liver transplantation were randomized to an infusion of either 8.4% sodium bicarbonate (0.5 mEq/kg/h for the first hour; 0.15 mEq/kg/h until completion of surgery); (n = 30) or 0.9% sodium chloride (n = 30).

Primary outcome: AKI within the first 48 h post-operatively.

Results: There were no significant differences between the two treatment groups with regard to baseline characteristics, model for end-stage liver disease and acute physiology and chronic health evaluation (APACHE) II scores, and pre-transplantation renal function. Intra-operative factors were similar for duration of surgery, blood product requirements, crystalloid and colloid volumes infused and requirements for vasoactive therapy. Eleven patients (37%) in the bicarbonate group and 10 patients (33%) in the sodium chloride group developed a post-operative AKI (p = 0.79). Bicarbonate infusion attenuated the degree of immediate post-operative metabolic acidosis; however, this effect dissipated by 48 h. There were no significant differences in ventilation hours, ICU or hospital length of stay, or mortality.

Conclusions: The intra-operative infusion of sodium bicarbonate did not decrease the incidence of AKI in patients following orthotopic liver transplantation.

Keywords: bicarbonate; kidney injury; liver transplantation.

Publication types

  • Clinical Trial
  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / drug therapy*
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology
  • Australia / epidemiology
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Survival
  • Humans
  • Incidence
  • Infusions, Intravenous
  • Kidney Function Tests
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pilot Projects
  • Postoperative Complications / drug therapy*
  • Prognosis
  • Risk Factors
  • Sodium Bicarbonate / therapeutic use*

Substances

  • Sodium Bicarbonate