Risk of Acute Kidney Injury in Living Liver Donor Surgery

Reducing Risk of Acute Kidney Injury After Living Donor Hepatectomy by Protocolized Fluid Restriction: Single-center Experience

Acute kidney injury (AKI) is one of the most common complication after restricted fluid therapy for major surgery. The aim of this study is to evaluate the incidence of AKI as defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria in living liver donor hepatectomy in which applied intraoperative protocolized fluid restriction targeting a low central venous pressure (CVP) level and high pulse pressure variation (PPV) / systolic pressure variation (SPV).

Study Overview

• Status: Completed
• Conditions: Acute Kidney Injury; Liver Transplant; Complications; Fluid and Electrolyte Imbalance

Detailed Description

Operative blood loss and need for transfusion are risk factors associated with mortality after partial hepatectomy. The low central venous pressure (CVP) anesthetic technique has been strongly advocated to minimize hepatic venous bleeding during hepatectomy. Low CVP technique for living donor hepatectomy may not be advantageous regarding the safety of healthy living donors. Safer, simpler, and more useful fluid management methods are, therefore, required to reduce blood loss and subsequent morbidity during living donor hepatectomy. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are the dynamic parameters of hemodynamic used to access the volume status and fluid responsiveness in mechanically ventilated patients.

Based only on the serum creatinine increase, AKI occurs in 5-15% of hepatectomy patients.In this study, we aimed to evaluate the incidence of AKI based on the change of serum creatinine levels in living liver donor hepatectomy regarding intraoperative fluid restriction targeting low CVP levels and high PPV and SPV depending on our protocolized fluid management.

130 living liver donors were admitted for a retrospective observational study. The low central venous pressure (<5 mmHg) and high pulse pressure variation (PPV<20%) / systolic pressure variation (SPV<15%) were applied to reduce intraoperative blood loss as fluid management until the end of the hepatic parenchymal division. AKI was defined using the KDIGO criteria according to the serum creatinine. The SPSS 11.5 program was used for statistical analysis.

• Study Type: Observational
• Enrollment (Actual): 130

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey, 06230
    • Süheyla Karadağ Erkoç

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

patients who underwent living liver donor hepatectomy

Description

Inclusion Criteria:

• patients who underwent living liver donor hepatectomy

Exclusion Criteria:

-

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acute kidney injury in living donor patients	Kidney Disease Improving Global Outcomes (KDIGO) criteria	one week

Collaborators and Investigators

• Sponsor: Ankara University
• Collaborators: Ali Abbas Yılmaz; Mustafa Kemal Bayar; Elvan Onur Kırımker; Sevcan Büyük; Elif Beyza Baskan; Deniz Balcı; Kaan Karayalçın

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 10, 2019
• Primary Completion (ACTUAL): June 1, 2020
• Study Completion (ACTUAL): June 10, 2021

Study Registration Dates

• First Submitted: February 14, 2022
• First Submitted That Met QC Criteria: February 15, 2022
• First Posted (ACTUAL): February 24, 2022

Study Record Updates

• Last Update Posted (ACTUAL): May 12, 2022
• Last Update Submitted That Met QC Criteria: May 9, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: acute kidney injury; central venous pressure; fluid therapy; Hemodynamic Monitoring; Living donors
• Additional Relevant MeSH Terms: Kidney Diseases; Urologic Diseases; Renal Insufficiency; Wounds and Injuries; Acute Kidney Injury
• Other Study ID Numbers: AnkaraUni

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No