Effect of cardiac output-guided hemodynamic management on acute kidney injury during pediatric liver transplantation / 中华器官移植杂志

ABSTRACT

Objective:To explore the effect of cardiac output-guided hemodynamic management on acute kidney injury(AKI)during pediatric liver transplantation.Methods:A total of 120 pediatric living-donor liver transplantation recipients were randomly divided into two groups of control and experiment(60 cases each group). Control group received routine hemodynamic management of central venous pressure(CVP), continuous invasive arterial pressure and blood gas analysis.Experiment group was subjected to cardiac output-guided hemodynamic management guided by cardiac index, stroke volume index, stroke volume variation and left ventricular contractility index (DP/DTmax). Intraoperative hemodynamics and incidence of AKI were recorded.And the serum changes of neutrophil gelatinase-associated lipocalin(NGAL), cystatin C(CysC)and inflammatory factors were analyzed.Results:The incidence of AKI was lower in experiment group than that in control group(26.7% vs 45%). The incidence of postreperfusion syndrome(PRS), intraoperative fluid infusion and maximal value of CVP were lower while minimal value of mean arterial pressure(MAP)higher in experiment group than those in control group( P<0.05). The serum levels of NGAL, CysC, interleukin-6(IL-6), interleukin-18(IL-18)and tumor necrosis level-alpha(TNF-α)were lower in experiment group than those in control group at each timepoint from 3 h post-reperfusion to 48 h post-operation( P<0.05). Conclusions:During pediatric living-donor liver transplantation, cardiac output-guided hemodynamic management is conducive to more accurate fluid management.It can stabilize circulation, minimize PRS and reduce the occurrence of AKI during perioperative period.