Renal function after low central venous pressure‐assisted liver resection: assessment of 2116 cases

Correa‐Gallego, Camilo; Berman, Alexandra; Denis, Stephanie C.; Langdon‐Embry, Liana; O'Connor, David C.; Arslan‐Carlon, Vittoria; Kingham, T. Peter; D’Angelica, Michael I.; Allen, Peter J.; Fong, Yuman; DeMatteo, Ronald P.; Jarnagin, William R.; Melendez, Jose; Fischer, Mary

doi:10.1111/hpb.12347

Cited by 48 publications

(34 citation statements)

References 33 publications

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“…Our findings are congruent with those reported by Correa-Gallego 17) . They reported that low central venous pressure-assisted hepatectomy was associated with AKI (17%).…”

Section: Discussionsupporting

confidence: 94%

Acute Kidney Injury after Hepatic Surgery with Goal Directed Fluid Therapy

Sakamoto

Kobayashi

Tanigawa

et al. 2015

J St. Marianna Univ

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Background: Goal-directed therapy (GDT) has been shown to reduce perioperative complications. However, whether the restriction of fluid volume in goal-directed therapy causes acute kidney injury (AKI) remains to be determined. The aim of this study was to determine intraoperative risk factors for AKI after hepatic surgery with goal-directed therapy using restricted fluid volume. Methods: Anesthesia and medical records of 67 patients who underwent hepatic resection were analyzed. Central venous pressure (CVP) and stroke volume variation (SVV) were monitored continuously by arterial contour analysis using a FloTrack sensor TM (Edwards life sciences LLC, CA, USA) for restrictive fluid management during portal triad clamping (PTC) with inferior vena cava (IVC) clamping. Low CVP (<5 cmH 2 O) and high SVV (>12%) were achieved by restrictive fluid management during PTC. AKI was assessed using the AKI network definition. Results: Eight patients developed stage-1 AKI (12%) after hepatic resection, but none of the patients required renal replacement therapy. The durations of anesthesia and PTC were longer in the AKI group than in the non-AKI group (P=0.006 and P=0.004). The IVC was clamped more frequently in the AKI group than in the non-AKI group (P=0.004). The amount of blood loss was larger and the necessity for blood transfusion was higher in the AKI group than in the non-AKI group (P=0.02 and P=0.001). Conclusion:The duration of PTC with IVC clamping and blood loss affects the incidence of AKI after hepatic surgery using GDT with restrictive fluid volume management. We suggest that unstable hemodynamics during PTC with IVC clamping and blood loss contribute to AKI after hepatic surgery.

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“…Our findings are congruent with those reported by Correa-Gallego 17) . They reported that low central venous pressure-assisted hepatectomy was associated with AKI (17%).…”

Section: Discussionsupporting

confidence: 94%

Acute Kidney Injury after Hepatic Surgery with Goal Directed Fluid Therapy

Sakamoto

Kobayashi

Tanigawa

et al. 2015

J St. Marianna Univ

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“…Twenty years ago, our group developed and reported a simple, effective and reproducible technique for decreasing the intraoperative blood loss in patients undergoing liver resection. [19] LCVP-assisted liver resection resulted in improved outcomes and has become the standard approach at our institution [20, 21] and others. [25-28] The success of this approach hinges on effective communication between the anesthesia and surgical teams during the operative and perioperative periods.…”

Section: Discussionmentioning

confidence: 99%

“…Once hemostasis has been achieved, infusion of an assumed volume of required resuscitation restores euvolemia. This approach while proven safe,[21] may under or overestimate the fluid needs of these patients and may not provide the optimal amount of resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…[19-21] Briefly, LCVP consists of two phases: a pre-hepatic transection which takes advantage of strict fluid restriction (overnight fluid replacement is withheld and maintenance fluid requirement at 1 ml/kg/hr of balanced crystalloid solution is infused until the liver resection is completed) and the vasodilatory effect of anesthetic agents to provide LCVP; during this phase, anesthesia is maintained with a combination of isoflurane in oxygen, and fentanyl. Isoflurane provides vasodilation with minimal myocardial depression.…”

Section: Methodsmentioning

confidence: 99%

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Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial

Correa‐Gallego

Tan

Arslan‐Carlon

et al. 2015

Journal of the American College of Surgeons

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Background The optimal perioperative fluid resuscitation strategy for liver resections (LR) remains undefined. Goal-directed therapy (GDT) embodies a number of physiologic strategies to achieve an ideal fluid balance and avoid the consequences of over- or under-resuscitation. Study Design In a prospective randomized trial, patients undergoing LR were randomized to GDT using stroke volume variation (SVV) as an endpoint or standard perioperative resuscitation (STD). Primary outcome measure was 30-day morbidity. Results Between 2012 and 2014, 135 patients were randomized (GDT: 69 – STD: 66). Median age was 57yrs, and 56% were male. Metastatic disease comprised 81% of patients. Overall (35% GDT vs 36% STD, p=0.86) and Grade 3 morbidity (28% GDT vs 18% STD, p=0.22) were equivalent. Patients in the GDT arm received less intraoperative fluid (mean 2.0 L GDT vs 2.9 L STD, p<0.001). Perioperative transfusions were required in 4% (6% GDT vs 2% STD, p=0.37) and boluses in the postanesthesia care unit (PACU) were administered to 24% (29% GDT vs 20% STD, p=0.23). Mortality rate was 1% (2/135 patients; both in GDT). On multivariable analysis, male gender, age, combined procedures, higher intraoperative fluid volume, and fluid boluses in PACU were associated with higher 30-day morbidity. Conclusions SVV-guided GDT is safe in patients undergoing LR and led to less intraoperative fluid. While the incidence of postoperative complications was similar in both arms, lower intraoperative resuscitation volume was independently associated with decreased postoperative morbidity in the entire cohort. Future studies should target extensive resections and identify patients receiving large resuscitation volumes, as this population is more likely to benefit from this technique.

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“…Furthermore, the long surgery duration of ~380 min during the first stage of ALPPS, along with the adverse effects of anesthesia and surgical stress on renal function possibly increased the risk and contributed to the development of acute kidney injury. Of patients undergoing the ALPPS procedure, 70% of cases presented liver metastasis from colorectal cancer, ~17% of patients presented primary liver cancer (2,10,11), and a small number of patients had liver cancer secondary to hepatitis-induced cirrhosis. The latter group of patients are more likely to suffer with viral nephropathy and are at a high risk of postoperative acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury following the first stage of the ALPPS procedure: A case report

2018

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Abstract. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel approach for performing liver resection, and the number of clinical applications of this technique has rapidly increased within recent years. ALPPS is important in patients who have insufficient residual liver volume and cannot undergo radical hepatic resection. The most common postoperative complications of ALPPS include biliary fistula and infection. To date, postoperative acute kidney injury following ALPPS has not been reported. The current study reports the case of a 63-year-old patient with hepatitis B-induced cirrhosis who underwent the first stage of ALPPS without completion of the second step. The patient developed postoperative acute kidney injury following ALPPS. The present case study suggests that the use of ALPPS in patients at risk of chronic renal damage should be approached with caution in order to avoid postoperative acute kidney injury. Furthermore, improvements in surgical techniques and skills of the surgeons performing the procedure are required to reduce the surgery duration and improve patient outcomes.

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Renal function after low central venous pressure‐assisted liver resection: assessment of 2116 cases

Cited by 48 publications

References 33 publications

Acute Kidney Injury after Hepatic Surgery with Goal Directed Fluid Therapy

Acute Kidney Injury after Hepatic Surgery with Goal Directed Fluid Therapy

Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial

Acute kidney injury following the first stage of the ALPPS procedure: A case report

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