Paediatric anaesthesia · 2025
Associations of Intraoperative Hypotension and Vasopressor Administration With Postoperative Acute Kidney Injury in Children Undergoing Liver Transplantation: A Retrospective Cohort Study.
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Wingert Theodora, Feldman Kelly, Williams Tiffany, Delaporte Amelie, Lum Matthew, Grogan Tristan, Nguyen-Buckley Christine, Joosten Alexandre
Аннотация
BACKGROUND: Both intraoperative hypotension (IOH) and vasopressor administration are independently associated with postoperative acute kidney injury (AKI) in adults undergoing major noncardiac surgery. Whether these associations extend to children undergoing major noncardiac surgery, such as liver transplantation, remains unknown.
AIMS: This study aimed to evaluate whether IOH, defined as time spent with a mean arterial pressure (MAP) less than one standard deviation (SD) below age- and sex-adjusted normal, and vasopressor administration in children are associated with postoperative AKI in liver transplantation (LT). We hypothesized that both IOH and vasopressor use would be independent predictors of postoperative AKI after pediatric LT.
METHODS: This single-center retrospective cohort study analyzed all patients < 18 years undergoing LT, excluding those with preoperative end-stage renal disease. The primary outcome was AKI, within 7 postoperative days defined according to KDIGO criteria. Multivariable logistic regression models were performed to determine whether IOH and vasopressor use, specifically maximum intraoperative epinephrine infusion, were independently associated with AKI. Exploratory K-means clustering was applied to IOH and vasopressor exposure to identify hemodynamic phenotypes, which were evaluated for associations with AKI and other outcomes.
RESULTS: Of 144 pediatric LT cases, 22 were excluded for preexisting renal failure, leaving 122 for analyses. Postoperative AKI occurred in 39%. The mean cumulative duration MAP was < 1 standard deviation of age- and sex-adjusted mean was 26.6 versus 26.1 min, respectively, among patients who developed AKI versus those who did not (mean difference 0.52 min: 95% CI -15.03, 16.07, p = 0.948). In the multivariate analysis neither hypotension (by the same definition) nor maximum epinephrine appeared to be associated with AKI: adjusted odds ratio 1.003 (95% CI: 0.992-1.014) and 1.003 (95% CI: 0.994-1.012). Exploratory cluster analysis revealed distinct intraoperative hemodynamic phenotypes based on IOH and vasopressor use, which were significantly associated with some perioperative outcomes, highlighting the need for larger studies with more robust control of patient factors.
CONCLUSIONS: IOH and vasopressor exposure were not independently associated with AKI in children undergoing LT.
AIMS: This study aimed to evaluate whether IOH, defined as time spent with a mean arterial pressure (MAP) less than one standard deviation (SD) below age- and sex-adjusted normal, and vasopressor administration in children are associated with postoperative AKI in liver transplantation (LT). We hypothesized that both IOH and vasopressor use would be independent predictors of postoperative AKI after pediatric LT.
METHODS: This single-center retrospective cohort study analyzed all patients < 18 years undergoing LT, excluding those with preoperative end-stage renal disease. The primary outcome was AKI, within 7 postoperative days defined according to KDIGO criteria. Multivariable logistic regression models were performed to determine whether IOH and vasopressor use, specifically maximum intraoperative epinephrine infusion, were independently associated with AKI. Exploratory K-means clustering was applied to IOH and vasopressor exposure to identify hemodynamic phenotypes, which were evaluated for associations with AKI and other outcomes.
RESULTS: Of 144 pediatric LT cases, 22 were excluded for preexisting renal failure, leaving 122 for analyses. Postoperative AKI occurred in 39%. The mean cumulative duration MAP was < 1 standard deviation of age- and sex-adjusted mean was 26.6 versus 26.1 min, respectively, among patients who developed AKI versus those who did not (mean difference 0.52 min: 95% CI -15.03, 16.07, p = 0.948). In the multivariate analysis neither hypotension (by the same definition) nor maximum epinephrine appeared to be associated with AKI: adjusted odds ratio 1.003 (95% CI: 0.992-1.014) and 1.003 (95% CI: 0.994-1.012). Exploratory cluster analysis revealed distinct intraoperative hemodynamic phenotypes based on IOH and vasopressor use, which were significantly associated with some perioperative outcomes, highlighting the need for larger studies with more robust control of patient factors.
CONCLUSIONS: IOH and vasopressor exposure were not independently associated with AKI in children undergoing LT.