Intraoperative Oxygen Delivery and Acute Kidney Injury after Liver Transplantation

Journal of Clinical Medicine

卷:9

Ho-Jin Lee¹  Hee-Chul Yoon¹  Kook Hyun Lee¹  Won Ho Kim¹  Kyung-Suk Suh² 

[1] Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;

[2] Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;

关键词: acute kidney injury;    liver transplantation;    oxygen delivery;    oxygen content;   

DOI  :  10.3390/jcm9020564

来源: DOAJ

【 摘 要 】

Although intraoperative hemodynamic variables were reported to be associated with acute kidney injury (AKI) after liver transplantation, the time-dependent association between intraoperative oxygen delivery and AKI has not yet been evaluated. We reviewed 676 cases of liver transplantation. Oxygen delivery index (DO₂I) was calculated at least ten times during surgery. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. The area under the curve (AUC) was calculated as below a DO₂I of 300 (AUC < 300), 400 and 500 mL/min/m² threshold. Also, the cumulative time below a DO₂I of 300 (Time < 300), 400, and 500 mL/min/m² were calculated. Multivariable logistic regression analysis was performed to evaluate whether AUC < 300 or time < 300 was independently associated with the risk of AKI. As a sensitivity analysis, propensity score matching analysis was performed between the two intraoperative mean DO₂I groups using a cutoff of 500 ml/min/m², and the incidence of AKI was compared between the groups. Multivariable analysis showed that AUC < 300 or time < 300 was an independent predictor of AKI (AUC < 300: odds ratio [OR] = 1.10, 95% confidence interval [CI] 1.06−1.13, time < 300: OR = 1.10, 95% CI 1.08−1.14). Propensity score matching yielded 192 pairs of low and high mean DO₂I groups. The incidence of overall and stage 2 or 3 AKI was significantly higher in the lower DO₂I group compared to the higher group (overall AKI: lower group, n = 64 (33.3%) vs. higher group, n = 106 (55.2%), P < 0.001). In conclusion, there was a significant time-dependent association between the intraoperative poor oxygen delivery <300 mL/min/m² and the risk of AKI after liver transplantation. The intraoperative optimization of oxygen delivery may mitigate the risk of AKI.

【 授权许可】

Unknown