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The investigators attempted to investigate the association of the type of crystalloid administered during liver transplantation with postoperative clinical outcomes. The investigators hypothesized that the greater amount of normal saline or half-saline administered during liver transplantation might be associated with the increased risk of acute kidney injury compared to the balanced crystalloids.
Liver transplantation requires a long operation time and is often associated with a significant amount of surgical bleeding. It is common for the anesthesiologist to infuse large amounts of fluid or blood products due to bleeding, hemodynamic instability, or ascites drainage. Therefore, in the anesthesia for liver transplantation, optimal management of fluid administration is necessary and the choice of the type of crystalloid may affect the prognosis or the incidence of postoperative complications of patients.
The investigators attempted to investigate the association of the type of crystalloid administered during liver transplantation with postoperative clinical outcomes. The investigators hypothesized that the greater amount of normal saline or half-saline administered during liver transplantation might be associated with the increased risk of acute kidney injury compared to the balanced crystalloids.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Balanced group | Patients who received balanced crystalloids of lactated Ringer's solution or plasma solution during liver transplantation surgery |
| |
| Saline group | Patients who received only normal saline during liver transplantation surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Normal saline | Drug | Patients received normal saline as a maintenance crystalloid during liver transplantation surgery. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Acute kidney injury | The investigators defined acute kidney injury by the KDIGO (Kidney Disease Improving Global Outcomes) criteria, which was determined according to the greatest change in serum creatinine level during the postoperative seven days (Stage 1: more than 1.5-fold; stage 2: more than 2-fold; stage 3: more than 3-fold increase of baseline or increase in SCr to ≥ 4.0 mg/dL or the initiation of renal replacement therapy). The most recent SCr level measured before surgery was collected as a baseline value. | the first 7 postoperative days |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of postoperative hemodialysis | the incidence of new-onset postoperative hemodialysis during hospitalization | the first month after admission |
| Early allograft dysfunction | One or more of the following are present within the first 7 postoperative days: total bilirubin ≥ 10 mg/dL, PT (prothrombin time):INR (international normalized ratio)≥ 1.6, or AST (aspartate aminotransferase)/ALT (alanine aminotransferase) > 2000 IU/L |
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Inclusion Criteria:
Exclusion Criteria:
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Patients received liver transplantation surgery in a single tertiary care university hospital
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ji-yoon Jung, MD | Contact | 82-2-2072-2469 | jiyooning1030@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Won Ho Kim, MD, PhD | Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Recruiting | Seoul | 03080 | South Korea |
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| Balanced crystalloid solution | Drug | Patients received balanced crystalloids such as lactated Ringer's solution or Plasma solution as a maintenance crystalloid during liver transplantation surgery. |
|
|
| the first 7 postoperative days |
| In-hospital mortality | all-cause mortality during hospitalization | the first month after admission |
| One-year mortality | all-cause mortality during one year after transplantation | one year after transplantation |
| Length of intensive care unit stay | Length of intensive care unit stay after transplantation | the first month after admission |
| Length of hospital stay | Length of hospital stay after transplantation | the first month after admission |
| ID | Term |
|---|---|
| D058625 | End Stage Liver Disease |
| D008103 | Liver Cirrhosis |
| ID | Term |
|---|---|
| D017093 | Liver Failure |
| D048550 | Hepatic Insufficiency |
| D008107 | Liver Diseases |
| D004066 | Digestive System Diseases |
| D005355 | Fibrosis |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000077330 | Saline Solution |
| D000077325 | Ringer's Lactate |
| C028035 | stable plasma protein solution |
| ID | Term |
|---|---|
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |
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