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J. Clin. Med. 2019, 8(1), 29; https://doi.org/10.3390/jcm8010029

Intraoperative Oliguria with Decreased SvO2 Predicts Acute Kidney Injury after Living Donor Liver Transplantation

1
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea
2
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
*
Author to whom correspondence should be addressed.
Received: 22 November 2018 / Revised: 17 December 2018 / Accepted: 24 December 2018 / Published: 28 December 2018
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Abstract

Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between intraoperative oliguria alone and oliguria coupled with hemodynamic derangement and the risk of AKI after LDLT. We evaluated the hemodynamic variables, including mean arterial pressure, cardiac index, and mixed venous oxygen saturation (SvO2). We reviewed 583 adult patients without baseline renal dysfunction and who did not receive hydroxyethyl starch during surgery. AKI was defined using the Kidney Disease Improving Global Outcomes criteria according to the serum creatinine criteria. Multivariable logistic regression analysis was performed with and without oliguria and oliguria coupled with a decrease in SvO2. The performance was compared with respect to the area under the receiver operating characteristic curve (AUC). Intraoperative oliguria <0.5 and <0.3 mL/kg/h were significantly associated with the risk of AKI; however, their performance in predicting AKI was poor. The AUC of single predictors increased significantly when oliguria was combined with decreased SvO2 (AUC 0.72; 95% confidence interval (CI) 0.68–0.75 vs. AUC of oliguria alone 0.61; 95% CI 0.56–0.61; p < 0.0001; vs. AUC of SvO2 alone 0.66; 95% CI 0.61–0.70; p < 0.0001). Addition of oliguria coupled with SvO2 reduction also increased the AUC of multivariable prediction (AUC 0.87; 95% CI 0.84–0.90 vs. AUC with oliguria 0.73; 95% CI 0.69–0.77; p < 0.0001; vs. AUC with neither oliguria nor SvO2 reduction 0.68; 95% CI 0.64–0.72; p < 0.0001). Intraoperative oliguria coupled with a decrease in SvO2 may suggest the risk of AKI after LDLT more reliably than oliguria alone or decrease in SvO2 alone. Intraoperative oliguria should be interpreted in conjunction with SvO2 to predict AKI in patients with normal preoperative renal function and who did not receive hydroxyethyl starch during surgery. View Full-Text
Keywords: acute kidney injury; urine output; hemodynamics; living-donor liver transplantation acute kidney injury; urine output; hemodynamics; living-donor liver transplantation
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    Description: Supplemental Table S1. Multivariable logistic regression analysis to predict acute kidney injury after liver transplantation without stepwise variable selection. Supplemental Table S2. Odds ratios (95% confidence intervals) and their P-values according to the categorized intraoperative urine flow rate with different cut-offs determined by both the univariable and multivariable logistic regression analysis for acute kidney injury of any stage in all patients. Supplemental Table S3. Subgroup analysis for the patients who had not received diuretics either before or during surgery (n=435). Odds ratios (95% confidence intervals) and their p-values according to the categorized intraoperative urine flow rate with different cut-offs determined by both the univariable and multivariable logistic regression analysis for acute kidney injury were shown. Supplemental Table S4. Comparisons of independent predictors of the multivariable logistic regression analysis of our study between male and female. Supplemental Figure S1. Distribution of mean urine flow rate during liver transplantation surgery in all patients (upper), and box and whisker plots of urine flow rate during liver transplantation surgery with and without postoperative acute kidney injury (lower).
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Kim, W.H.; Lee, H.-C.; Lim, L.; Ryu, H.-G.; Jung, C.-W. Intraoperative Oliguria with Decreased SvO2 Predicts Acute Kidney Injury after Living Donor Liver Transplantation. J. Clin. Med. 2019, 8, 29.

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