Metabolic alkalosis following orthotopic liver transplantation

Abstract

Objective:To determine the incidence, causative factors and impact of post-operative metabolic alkalosis in liver transplant recipients. Design: Retrospective.Setting: Post-operative intensive care unit. Subjects: Eighty adult liver transplant recipients.Interventions: Arterial blood gases were assessed on postoperative days one, two and three.Endpoints: Metabolic alkalosis was defined as the presence of a standard bicarbonate level ≥ ≥ ≥ ≥ ≥26 mEq/l in one or more determinations. Measurements and main results: Sixty-five patients (81%) developed post-operative metabolic alkalosis (Group 1). They had required a greater transfusion of intraoperative blood (28±22 units versus 14±10 units; p<0.01) and fresh frozen plasma (38.5±27.4 units versus 17.3±7.8 units; p<0.01) than the 15 patients without metabolic alkalosis (Group 2). There were no differences in the intraoperative infusion of sodium bicarbonate, type of fluids employed to restore blood volume, type of graft preservation solution, degree of preoperative liver insufficiency, post-operative fluid balance, gastric aspirate or graft function. This suggests that these factors are not associated with metabolic alkalosis. The PaO 2 and PaCO 2 values at extubation were similar in the two groups. There was no significant difference in the duration of mechanical ventilation (32±20 hours in Group 1 versus 34±16 hours in Group 2), in 6hour post-extubation PaCO 2 values (5.2±0.6 kPa [40.2±4.8 mmHg] in Group 1 versus 5.3±0.6kPa [40.7±4.3 mmHg] in Group 2), or in 30-day survival (74% in Group 1 versus 82% in Group 2). Conclusions: Metabolic alkalosis is a common finding inKey words: Blood transfusionImmediate post-operative period Liver transplantation Metabolic alkalosisStandard bicarbonate the first 72 hours after liver transplantation and is related to increased blood transfusion. Since it does not induce consequential hypoventilation or prolong the duration of mechanical ventilation, its treatment is not usually justified.