Intraoperative Hemodynamics and Development of Renal Dysfunction After Liver Transplantation in Recipients With Normal Renal Function.

Abstract

Renal vasoconstriction due to intraoperative hypotension and alterations in vascular flow during liver transplantation (LT) may predispose to renal dysfunction. We hypothesized that suboptimal intraoperative hemodynamics in subjects with preserved renal function prior to LT predict renal dysfunction 1 year after LT. We examined all transplants at our center between 2002 and April 2011 and identified subjects with preserved renal function at the time of transplant (serum creatinine <1.5 mg/dL and a calculated glomerular filtration rate >60ml/min (MDRD-6)). Primary outcome of interest was development of renal dysfunction 1 year after LT (GFR<60ml/min as measured by protocol iothalamate clearance). We adjusted for known donor, recipient and post-transplant factors to examine the independent effect of intraoperative factors on development of renal dysfunction using logistic regression analysis. Variable selection approach based on a combination of stepwise logistic regression, information criteria, and best subset selection was used to identify the final model. Split-Sample (70/30) validation was conducted to define the model’s predictive ability. Overall, 729 subject met inclusion criteria; 369 had measured GFR by iothalamate clearance; 227 had GFR ≤ 60 ml/min (61.5%) at 1 year. After adjusting for known pre-transplant, donor and post-transplant factors, receipt of > 5 units packed RBC (p=0.004), cardiac output less than 7L/min (p=0.01), mean arterial pressure <72mmHg (p=0.02), and portal blood flow <2L/min (p=0.1) were predictive of measured GFR <60ml/min at 1 year (c=0.70). Similar results were obtained on prediction of renal dysfunction at 3 months. Intraoperative changes in vascular flow and intraoperative hypotension may lead to renal vasoconstriction predisposing to renal failure after liver transplantation. Identification of subset of recipients at the end of LT with propensity to develop renal dysfunction may allow for early renal preserving interventions even among recipients with preserved renal function.Table: No Caption available.