Fluid management guided by stroke volume variation failed to decrease the incidence of acute kidney injury, 30-day mortality, and 1-year survival in living donor liver transplant recipients

Abstract

The outcomes of living donor liver transplant patients who had fluid therapy guided by an SVV less than 10% were similar to those of patients who were given fluids to reach a CVP of 10 mmHg. Our findings suggest that the two measures of vascular filling are similar in liver transplant recipients with demographic characteristics similar to those of our patients.

Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

“…We found 29 observational cohort studies, with all except two studies 40,43 being considered at high or critical RoB. Among the 14 exposure-based cohort studies, [38][39][40][41][42][43][44][45][46][47][48][49][50][51] nine collected data from the intraoperative period: three compared low CVP with another strategy (one compared two centres using different protocols 38 ; one compared two groups retrospectively classified as to CVP values after reperfusion 39 ; and one compared low CVP with goaldirected therapy in a before-after study) 40 ; one compared stroke volume variation (SVV) goal-directed therapy with high-CVP management 41 ; two from the same centre compared the use of phlebotomies with either unmatched historical controls (before-after study) 42 or contemporary controls 43 ; two compared two retrospectively classified groups (one based on SVV 44 and one based on the volume of fluid received) 45 ; and one compared two groups in a before-after study (practice changed over time toward a more restrictive approach). 46 Three studies collected data for the complete perioperative period (intraoperative and postoperative periods): two before-after studies compared patients receiving a restrictive fluid management (either restrictive goal-directed therapy 47 or a fast-track bundle that included restricting fluid) 48 with unmatched historical controls and one compared two retrospectively classified albumin-treated groups.…”

“…38,[40][41][42]44,49,67 Three intraoperative studies and one perioperative study did not show any effect. 41,44,49,67 One study reported that a restrictive strategy significantly increased the need for RRT (not supported by our calculated OR; see Table 2). 38 One before-after intraoperative study showed a higher incidence of AKI in the restrictive group This study is a three-arm study.…”

“…34 The second RCT performed during the postoperative period reported a comparable three-month mortality between three different groups. 36 Among the twelve cohort studies reporting data on mortality, eleven studies did not show any effect [38][39][40][41][42]44,[47][48][49][50]67 and one study reported a lower one-year mortality with the use of intraoperative phlebotomy as part of a restrictive strategy (OR, 0.50; 95% CI, 0.27 to 0.92) 43 (eTable 3a).…”

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation

“…[16,17] The CVP is being replaced with the new hemodynamic parameter, such as stroke volume variation (SVV), which may be used as a surrogate to measure shifts in position of the Frank-Starling curve, for optimal fluid management in the patients receiving mechanical ventilation. Despite the superiority of SVV to CVP, the promising results of its use in the patients undergoing LT or KT are emerging [18,19] and there are no studies reporting the usefulness of SVV in CKLT at this point. However, some previous studies have reported CVP-targeting fluid management for LT or KT.…”

Should Low Central Venous Pressure Be Maintained during Liver Transplantation?

“…Despite its better performance for fluid management, the use of stroke volume variation did not decrease the incidence of acute kidney injury or of 30-day and 1-year mortality compared to the use of central venous pressure [11]. In addition, unlike with central venous pressure, assessing intravascular volume status by measuring stroke volume variation was not associated with a postoperative decrease in portal hyperperfusion [7].…”