title: Is there a relationship between intraoperative hemodynamic instability and calcineurin inhibitor-related toxicity, early after liver transplantation? A single-center observational study.
abstract: This study evaluated the relationship between intraoperative hemodynamic instability (IOHI) and the development of calcineurin inhibitor (CNI) toxicity in the early postoperative period after liver transplantation (LT). Eighty-two patients were enrolled during a 1-year period and a 3-month follow-up. IOHI, requiring continuous infusion of vasopressors, was observed in 31 patients (38%, group 1; control group 2, n = 51). Acute kidney injury (AKI) developed in 28 patients (52% in group 1 vs 24% in group 2, P = .02), and CNI-related neurotoxicity (CNI-NT) in 26 (48% in group 1 vs 22% in group 2, P = .03). Group 1 patients received mainly deceased donor grafts (87% vs 57% in group 2, P < .001). An independent association between IOHI and CNI-NT (P = .029) and AKI (P = .016) was observed. The receiver-operator characteristic curve revealed an area under the curve of 0.63 for IHI (sensitivity 56%; specificity 75%) and 0.65 for AKI (sensitivity 56%; specificity 70.2%). In conclusion, patients undergoing LT with IOHI may be more prone to developing CNI-NT and AKI in the early postoperative period.
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: T
authors.initials: T
authors.lastname: Capela
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: I
authors.initials: I
authors.lastname: Tavares
authors.affiliation: CEDOC, Faculdade de Ciências Médicas, Lisbon, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.affiliation: CEDOC, Faculdade de Ciências Médicas, Lisbon, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Vigia
authors.affiliation: CEDOC, Faculdade de Ciências Médicas, Lisbon, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Perdigoto
authors.affiliation: CEDOC, Faculdade de Ciências Médicas, Lisbon, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Barroso
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal. Electronic address: p.marcelino@netcabo.pt.
authors.forename: P
authors.initials: P
authors.lastname: Marcelino
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology; D011183:Postoperative Complications / Q000139:chemically induced*; D011446:Prospective Studies; D012372:ROC Curve; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D065095:Calcineurin Inhibitors; D014662:Vasoconstrictor Agents