Clinical trial NCT05255510: Risk of Acute Kidney Injury in Living Liver Donor Surgery
Official title: Reducing Risk of Acute Kidney Injury After Living Donor Hepatectomy by Protocolized Fluid Restriction: Single-center Experience
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Acute Kidney Injury
Liver Transplant; Complications
Fluid and Electrolyte Imbalance
Keywords: Living donors
acute kidney injury
central venous pressure
Hemodynamic Monitoring
fluid therapy
Lead sponsor: Ankara University
Sponsor class: OTHER
Collaborators: name: Elvan Onur Kırımker
name: Sevcan Büyük
name: Elif Beyza Baskan
name: Ali Abbas Yılmaz
name: Deniz Balcı
name: Kaan Karayalçın
name: Mustafa Kemal Bayar
First posted: 2022-02-24
Enrollment: 130
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: patients who underwent living liver donor hepatectomy

Brief summary: 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).

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.

Eligibility criteria: Inclusion Criteria:

* patients who underwent living liver donor hepatectomy

Exclusion Criteria:

-

Primary outcomes:
measure: Acute kidney injury in living donor patients
timeFrame: one week
Secondary outcomes:
Other outcomes:
Locations:
city: Ankara
country: Turkey
facility: Süheyla Karadağ Erkoç
Study officials:
affiliation: Ankara University
name: Süheyla Karadağ Erkoç
role: PRINCIPAL_INVESTIGATOR
References: