Fluid management guided by stroke volume variation failed to decrease the incidence of acute kidney injury, 30-day mortality, and 1-year survival in living donor liver transplant recipients

摘要

Background: Low central venous pressure (CVP) produced by fluid restriction has been applied to liver transplant recipients in order to decrease blood loss. However, CVP is not reliable for monitoring intravascular volume and ventricular filling. In addition, doubts remain over the association between fluid restriction and acute kidney injury (AKI). We tested the utility of stroke volume variation (SVV), derived from the FloTrac/Vigileo system, as a decision-making tool in fluid management. We examined the differences in fluid administration, urine output, postoperative AKI, and 30-day and 1-year survival rates between liver transplant recipients with fluid management guided by SVV and CVP. Methods: We retrospectively collected data on our liver transplant recipients with a Model for End-stage Liver Disease score less than 30 and serum creatinine lower than 1.5?mg/dL from 2007 to 2010. Recipients in 2007 and 2008 who received CVP-guided fluid management served as the control group. Recipients in 2009 and 2010 who received fluid administration triggered by SVV were recruited as the study group. The estimated blood loss, urine output, and fluid administered during the operation were recorded. Renal function was assessed using the RIFLE criteria on postoperative days 1 and 5. We also recorded the 30-day and 1-year survival. Results: Significantly more diuretic use and urine output were noted in the control group in spite of similar fluid administration. However, there was no significant difference in blood loss, AKI, or 30-day and 1-year survival rates. Conclusion: The outcomes of living donor liver transplant patients who had fluid therapy guided by an SVV less than 10% were similar to those of patients who were given fluids to reach a CVP of 10?mmHg. Our findings suggest that the two measures of vascular filling are similar in liver transplant recipients with demographic characteristics similar to those of our patients.