Intra-operative restricted fluid therapy in adult living donor liver transplant - Insights from a single-centre historical cohort study.

BACKGROUND AND AIMS: With the evolution of liver transplant anaesthesia, judicious intraoperative fluid management has been widely recommended. However, existing literature on a weight-based restricted fluid strategy is limited. Our institution follows a weight-based, restrictive fluid approach with maintenance therapy at 4 ml/kg/h (2 ml/kg/h crystalloids + 2 ml/kg/h 4% albumin solution) and goal-directed fluid boluses (4 ml/kg 4% albumin solution).

METHODS

This retrospective study analysed 106 adult living donor liver transplant recipients managed with a protocolised restrictive fluid strategy and compared them with 148 historical controls who received conventional fluid therapy. The primary outcomes were early extubation (extubated on table or within 6 hours post-operatively) and incidence of post-operative acute kidney injury (AKI) on post-operative days (POD) 1 and 3. Secondary outcomes included intra-operative blood transfusion requirement, vasopressor use, and vascular complication rate. Data were analysed using statistical package for the social sciences version 22 and Epi Info version 7.2.1.

RESULTS

The restrictive group received significantly lower total fluid volumes (3284 ± 833 ml vs. 3979 ± 1524 ml; P < 0.001), had higher on-table extubation rates (83% vs. 71.3%; P = 0.031), and experienced zero AKI by POD3 compared to 13.6% in the conventional group (P < 0.001). Serum creatinine was lower on POD1 and POD3 in the restrictive group. Vasopressin use was higher (P < 0.001) in the cases, while noradrenaline and blood transfusion requirements were comparable between the groups.

CONCLUSION

Our protocolised weight-based restrictive fluid regimen was associated with improved pulmonary outcomes without increased renal dysfunction. However, prospective studies with larger cohorts are required to validate our findings.