Effects of intraoperative hemodynamic management on postoperative acute kidney injury in liver transplantation: An observational cohort study

PLoS One. 2020 Aug 18;15(8):e0237503. doi: 10.1371/journal.pone.0237503. eCollection 2020.


Background: Intraoperative restrictive fluid management strategies might improve postoperative outcomes in liver transplantation. Effects of vasopressors within any hemodynamic management strategy are unclear.

Methods: We conducted an observational cohort study on adult liver transplant recipients between July 2008 and December 2017. We measured the effect of vasopressors infused at admission in the intensive care unit (ICU) and total intraoperative fluid balance. Our primary outcome was 48-hour acute kidney injury (AKI) and our secondary outcomes were 7-day AKI, need for postoperative renal replacement therapy (RRT), time to extubation in the ICU, time to ICU discharge and survival up to 1 year. We fitted models adjusted for confounders using generalized estimating equations or survival models using robust standard errors. We reported results with 95% confidence intervals.

Results: We included 532 patients. Vasopressors use was not associated with 48-hour or 7-day AKI but modified the effects of fluid balance on RRT and mortality. A higher fluid balance was associated with a higher need for RRT (OR = 1.52 [1.15, 2.01], p<0.001 for interaction) and lower survival (HR = 1.71 [1.26, 2.34], p<0.01 for interaction) only among patients without vasopressors. In patients with vasopressors, higher doses of vasopressors were associated with a higher mortality (HR = 1.29 [1.13, 1.49] per 10 μg/min of norepinephrine).

Conclusion: The presence of any vasopressor at the end of surgery was not associated with AKI or RRT. The use of vasopressors might modify the harmful association between fluid balance and other postoperative outcomes. The liberal use of vasopressors to implement a restrictive fluid management strategy deserves further investigation.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury* / epidemiology
  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / prevention & control
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Fluid Therapy / methods
  • Hemodynamics / physiology*
  • Humans
  • Intraoperative Care / methods*
  • Liver Transplantation / adverse effects*
  • Liver Transplantation / methods
  • Liver Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Quebec / epidemiology
  • Renal Replacement Therapy / statistics & numerical data
  • Risk Factors
  • Treatment Outcome
  • Water-Electrolyte Balance / physiology

Grant support

Dr Carrier (FMC) received a grant by the Fondation du CHUM (“Don d’organes et transplantation” program) to complete this work. Dr Chassé (MC) and Dr Sylvestre (MPS) are recipients of a Career Award Junior 1 from the Fonds de la Recherche du Québec – Santé. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.