title: Sodium bicarbonate infusion in patients undergoing orthotopic liver transplantation: a single center randomized controlled pilot trial.
abstract: Liver transplantation-associated acute kidney injury (AKI) carries significant morbidity and mortality. We hypothesized that sodium bicarbonate would reduce the incidence and/or severity of liver transplantation-associated AKI.
  
  
  
  In this double-blinded pilot RCT, adult patients undergoing orthotopic liver transplantation were randomized to an infusion of either 8.4% sodium bicarbonate (0.5 mEq/kg/h for the first hour; 0.15 mEq/kg/h until completion of surgery); (n = 30) or 0.9% sodium chloride (n = 30).
  
  
  
  AKI within the first 48 h post-operatively.
  
  
  
  There were no significant differences between the two treatment groups with regard to baseline characteristics, model for end-stage liver disease and acute physiology and chronic health evaluation (APACHE) II scores, and pre-transplantation renal function. Intra-operative factors were similar for duration of surgery, blood product requirements, crystalloid and colloid volumes infused and requirements for vasoactive therapy. Eleven patients (37%) in the bicarbonate group and 10 patients (33%) in the sodium chloride group developed a post-operative AKI (p = 0.79). Bicarbonate infusion attenuated the degree of immediate post-operative metabolic acidosis; however, this effect dissipated by 48 h. There were no significant differences in ventilation hours, ICU or hospital length of stay, or mortality.
  
  
  
  The intra-operative infusion of sodium bicarbonate did not decrease the incidence of AKI in patients following orthotopic liver transplantation.
authors.affiliation: Department of Anesthesia, The University of Melbourne, Melbourne, Vic., Australia.|Department of Surgery and Centre for Anesthesia, Perioperative and Pain Medicine, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Laurence
authors.initials: L
authors.lastname: Weinberg
authors.affiliation: Department of Anesthesia, Austin Hospital, Heidelberg, Vic., Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Broad
authors.affiliation: Department of Anesthesia, Austin Hospital, Heidelberg, Vic., Australia.
authors.forename: Param
authors.initials: P
authors.lastname: Pillai
authors.affiliation: Department of Anesthesia, Austin Hospital, Heidelberg, Vic., Australia.
authors.forename: Guangjun
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Anesthesia, Austin Hospital, Heidelberg, Vic., Australia.|Department of Anesthesiology, CHUM St-Luc Hospital, Montreal, QC, Canada.
authors.forename: Micheline
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Faculty of Health, School of Nursing & Midwifery, Deakin University, Heidelberg, Vic., Australia.|Faculty of MN&HS, Monash University, Heidelberg, Vic., Australia.|Austin Hospital, Heidelberg, Vic., Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Anesthesia, Austin Hospital, University of Melbourne, Heidelberg, Vic., Australia.|Department of Surgery, Austin Hospital, University of Melbourne, Heidelberg, Vic., Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Scurrah
authors.affiliation: Department of Surgery, Austin Hospital, Heidelberg, Vic., Australia.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.affiliation: Centre for Anesthesia, Perioperative and Pain Medicine, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: David
authors.initials: D
authors.lastname: Story
authors.affiliation: Austin Hospital, Heidelberg, Vic., Australia.
authors.forename: Larry
authors.initials: L
authors.lastname: McNicol
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Vic., Australia.|The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D001315:Australia / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000188:drug therapy*; D011379:Prognosis; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000627:therapeutic use*
chemical_list: D017693:Sodium Bicarbonate
keywords: bicarbonate; kidney injury; liver transplantation