Cumulative positive fluid balance is a risk factor for acute kidney injury and requirement for renal replacement therapy after liver transplantation.

Autor:	Codes L; Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia 40140-901, Brazil., de Souza YG; Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia 40140-901, Brazil., D'Oliveira RAC; Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia 40140-901, Brazil., Bastos JLA; Medical School of Bahia, Federal University of Bahia, Bahia 40110-100, Brazil., Bittencourt PL; Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia 40140-901, Brazil.
Jazyk:	angličtina
Zdroj:	World journal of transplantation [World J Transplant] 2018 Apr 24; Vol. 8 (2), pp. 44-51.
DOI:	10.5500/wjt.v8.i2.44
Abstrakt:	Aim: To analyze whether fluid overload is an independent risk factor of adverse outcomes after liver transplantation (LT). Methods: One hundred and twenty-one patients submitted to LT were retrospectively evaluated. Data regarding perioperative and postoperative variables previously associated with adverse outcomes after LT were reviewed. Cumulative fluid balance (FB) in the first 12 h and 4 d after surgery were compared with major adverse outcomes after LT. Results: Most of the patients were submitted to a liberal approach of fluid administration with a mean cumulative FB over 5 L and 10 L, respectively, in the first 12 h and 4 d after LT. Cumulative FB in 4 d was independently associated with occurrence of both AKI and requirement for renal replacement therapy (RRT) (OR = 2.3; 95%CI: 1.37-3.86, P = 0.02 and OR = 2.89; 95%CI: 1.52-5.49, P = 0.001 respectively). Other variables on multivariate analysis associated with AKI and RRT were, respectively, male sex and Acute Physiology and Chronic Health Disease Classification System (APACHE II) levels and sepsis or septic shock. Mortality was shown to be independently related to AST and APACHE II levels (OR = 2.35; 95%CI: 1.1-5.05, P = 0.02 and 2.63; 95%CI: 1.0-6.87, P = 0.04 respectively), probably reflecting the degree of graft dysfunction and severity of early postoperative course of LT. No effect of FB on mortality after LT was disclosed. Conclusion: Cumulative positive FB over 4 d after LT is independently associated with the development of AKI and the requirement of RRT. Survival was not independently related to FB, but to surrogate markers of graft dysfunction and severity of postoperative course of LT. Competing Interests: Conflict-of-interest statement: There are no conflicts of interest relevant to the conduct of this study.
Databáze:	MEDLINE
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