title: Relationship Between Intraoperative Hypotension and Acute Kidney Injury After Living Donor Liver Transplantation: A Retrospective Analysis.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is common after liver transplantation (LT) and has a significant impact on outcomes. Although several risk factors for post-LT AKI have been identified, the effect of intraoperative hemodynamic status on post-LT AKI remains unknown. Therefore, the authors aimed to investigate the relationship between hemodynamic parameters during LT and postoperative AKI.
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Patients who underwent living donor LT (n = 231).
  
  
  METHODS
  None.
  
  
  RESULTS
  Severe AKI (stages 2-3 according to recent guidelines) was the primary outcome. Multivariable logistic regression analysis was used to control for confounding variables to obtain the independent relationship between intraoperative hemodynamic parameters (mean arterial pressure [MAP] and cardiac index) and severe AKI. The prevalence of severe AKI was 30.7%. Nadir MAP during the surgery was independently predictive of severe AKI (adjusted odds ratio, 2.11 [95% confidence interval, 1.32-3.47] per 10-mmHg decrease; p = 0.002). Subgroup analyses based on various patient or operative variables and extensive sensitivity analyses showed substantially similar results. Severe hypotension (MAP<40 mmHg), even for fewer than 10 minutes, was related significantly to severe AKI (adjusted odds ratio, 3.80 [95% confidence interval, 1.17-12.30]; p = 0.026). In contrast, nadir cardiac index was not related significantly to severe AKI.
  
  
  CONCLUSIONS
  The authors found an independent relationship between degree of intraoperative hypotension and risk of severe AKI in living donor LT recipients. Severe hypotension, even for a short duration, was related significantly to severe AKI.
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan. Electronic address: mizota@kuhp.kyoto-u.ac.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mizota
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Hamada
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Shino
authors.initials: S
authors.lastname: Matsukawa
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hideya
authors.initials: H
authors.lastname: Seo
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Segawa
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000639:trends; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies
keywords: acute kidney injury; hypotension; liver transplantation; living donors; outcomes; risk factors