Hypotonic fluids after liver transplantation may be associated with prolonged ICU stay

Introduction

Morbidity after liver transplantation has been linked with preoperative MELD scores and transfusion volumes [1]. We hypothesized that in the immediate post-transplant period there may be modifiable risk factors associated with prolonged ICU stays.

Methods

In a retrospective, case-control study, we reviewed all liver transplant adult recipients over a 33-month period, January 2010 to September 2013. Recipients were divided into two groups based on a priori determined cutoff value of 8 days after transplantation. Significant associations for prolonged ICU admission were identified using chi-square analysis for categorical and ANOVA for continuous variables. P < 0.05 was considered significant. SPSS version 22.0 was used for all analyses.

Results

Total numbers of transplants performed were 162. Mean pretransplant MELD score was 19.5 ± 7.7; viral hepatitis was the most common indication for transplant, 44 (27%). Living-related donor transplants were carried out in 87 (54%) cases. Median ICU length of stay was 4 ± 11.9 days and ICU mortality was 15 (9%). Acute kidney injury developed in 30 (19%) with 5% needing renal replacement therapy. Early complications developed in 33%. Prolonged ICU stay was related to: a higher pre-transplant INR (P = 0.000), larger volumes of RBC (2,064 ± 1,701 vs. 1,176 ± 1,454 ml, P = 0.000), platelets (453 ± 271 vs. 365 ± 276 ml, P = 0.046) and cryoprecipitate transfusions (47 ± 98 vs. 23 ± 85 ml, P = 0.037) received in the OR and mean volumes of hypotonic crystalloids administered in the first 24 hours (P = 0.002), 48 hours (P = 0.010) and 72 hours (P = 0.007) of ICU admission. Serum sodium, chloride, lactate or creatinine levels were not significantly different between the two groups.

Conclusion

The administration of hypotonic fluids in the first 72 hours of liver transplantation may be a risk factor for prolonged ICU admission. This effect appears independent of serum electrolyte levels or renal dysfunction.