Insulin Therapy in Divided Doses Coupled With Blood Transfusion Versus Large Bolus Doses in Patients at High Risk for Hyperkalemia During Liver Transplantation

Xia, Victor W.; Obaidi, Rafee A.; Park, Chul‐Soo; Braunfeld, Michelle; Neelakanta, Gundappa; Nourmand, Hamid; Hu, Ke; Steadman, Randolph H.

doi:10.1053/j.jvca.2009.01.032

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…The administration of a large bolus of insulin during the anhepatic stage has been approved as an effective method for preventing postreperfusion hyperkalemia . In a previous study, we also showed that an insulin regimen targeting risk factors (high baseline K + concentration and RBC transfusions) could be effective in reducing the incidence of postreperfusion hyperkalemia . On the basis of the findings of this study, we recommend the inclusion of DCD grafts on the list of risk factors used in the target regimen for hyperkalemia.…”

Section: Discussionmentioning

confidence: 57%

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

et al. 2014

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Donation after cardiac death (DCD) is an important source for expanding the donor pool for liver transplantation (LT).Although the long-term outcomes of LT using DCD grafts have been extensively studied, perioperative complications related to DCD grafts are rarely reported. The aim of this study was to determine whether DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed. Postreperfusion complications and posttransplant outcomes were compared between patients receiving DCD grafts and patients receiving donation after brain death (DBD) grafts. In all, 74 patients received DCD grafts during the study period, and 1369 patients received DBD grafts. An initial comparison showed that many preoperative, prereperfusion, and donor variables in the DCD group differed significantly from those in the DBD group. Propensity matching was chosen so that adjustments could be made for the differences. A postmatching analysis showed that the preoperative, prereperfusion, and donor variables no longer differed between the 2 groups. The postreperfusion requirements for blood products and vasopressors, the posttransplant ventilation times, the incidence of posttransplant acute renal injury, and the 30-day and 1-year patient and graft survival rates were comparable between the 2 groups. However, patients receiving DCD grafts experienced significantly higher rates of hyperkalemia (33.8% versus 18.9%, P < 0.05) and postreperfusion syndrome (PRS; 25.7% versus 12.3%, P < 0.05). In conclusion, after adjustments for preoperative and prereperfusion risks via propensity matching, DCD grafts remained a risk factor for postreperfusion hyperkalemia and PRS. A prophylactic regimen aimed at decreasing postreperfusion hyperkalemia and PRS is recommended for the management of LT using DCD grafts. Liver The demand for organs for liver transplantation (LT) continues to exceed the supply. The discrepancy between the number of available organs and the number of patients waiting for transplantation remains significant. 1 To address this urgent shortage and the rising wait-list mortality rate, the expansion of the donor pool through the use of donation after cardiac death (DCD) grafts has been promoted. 2 Although donation after brain death (DBD) remains the predominant source of deceased donor grafts, the use of DCD grafts in LT is being increasingly accepted worldwide. Now LT using DCD grafts accounts for approximately 5% of all Abbreviations: ARI, acute renal injury; BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after cardiac death; DWIT, donor warm ischemia time; FFP, fresh frozen plasma; GWIT, graft warm ischemia time; ICU, intensive care unit; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; PRS, postreperfusion syndrome; RBC, red blood cell; UCLA, Univer...

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Section: Discussionmentioning

confidence: 57%

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

et al. 2014

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“…Of the 29 unique non‐randomised interventional studies identified in this SLR, 13 investigated temporising agents and 6 ZS or organic cation‐binding agents for the management of hyperkalaemia . Twelve out of 43 unique observational studies identified in the SLR reported on management of hyperkalaemia with SPS or CPS and 11 focused on temporising agents; however, a comparison of temporising agents was not in the scope of this work, given their use in the emergency setting …”

Section: Resultsmentioning

confidence: 99%

Evidence in support of hyperkalaemia management strategies: A systematic literature review

et al. 2018

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“…[6][7][8]18,19 Ammori et al evaluated 184 diabetic and nondiabetic liver transplant recipients. 6 They reported that intraoperative hyperglycemia was associated with an increased risk of postoperative infection and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…18 The total patient population was 717, and 50 of the patients received the divided dose regimen. The authors found that this therapy was useful for preventing increased serum potassium levels.…”

Section: Discussionmentioning

confidence: 99%

Blood Glucose Regulation During Living-Donor Liver Transplant Surgery

Gedik

H²,

Koca³

et al. 2015

Exp Clin Transplant

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Objectives: The goal of this study was to compare the effects of 2 different regimens on blood glucose levels of living-donor liver transplant. Materials and Methods:The study participants were randomly allocated to the dextrose in water plus insulin infusion group (group 1, n = 60) or the dextrose in water infusion group (group 2, n = 60) using a sealed envelope technique. Blood glucose levels were measured 3 times during each phase. When the blood glucose level of a patient exceeded the target level, extra insulin was administered via a different intravenous route. The following patient and procedural characteristics were recorded: age, sex, height, weight, body mass index, end-stage liver disease, Model for End-Stage Liver Disease score, total anesthesia time, total surgical time, and number of patients who received an extra bolus of insulin. The following laboratory data were measured pre-and postoperatively: hemoglobin, hematocrit, platelet count, prothrombin time, international normalized ratio, potassium, creatinine, total bilirubin, and albumin. Results: No hypoglycemia was noted. The recipients exhibited statistically significant differences in blood glucose levels during the dissection and neohepatic phases. Blood glucose levels at every time point were significantly different compared with the first dissection time point in group 1. Excluding the first and second anhepatic time points, blood glucose levels were significantly different as compared with the first dissection time point in group 2 (P < .05). Conclusions:We concluded that dextrose with water infusion alone may be more effective and result in safer blood glucose levels as compared with dextrose with water plus insulin infusion for living-donor liver transplant recipients. Exogenous continuous insulin administration may induce hyperglycemic attacks, especially during the neohepatic phase of living-donor liver transplant surgery. Further prospective studies that include homogeneous patient subgroups and diabetic recipients are needed to support the use of dextrose plus water infusion without insulin.

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Insulin Therapy in Divided Doses Coupled With Blood Transfusion Versus Large Bolus Doses in Patients at High Risk for Hyperkalemia During Liver Transplantation

Cited by 14 publications

References 14 publications

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Evidence in support of hyperkalaemia management strategies: A systematic literature review

Blood Glucose Regulation During Living-Donor Liver Transplant Surgery

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