Predictors of alkalosis after liver transplantation

• Published in: American journal of kidney diseases Vol. 40; no. 3; pp. 517 - 524
• Main Authors: Contreras, Gabriel, Garces, Galo, Reich, James, Banerjee, Debasish, Young, Larry, Cely, Cynthia, Gadalean, Florin, Perez, Guido, Roth, David
• Format: Journal Article
• Language: English
• Published: Orlando, FL Elsevier Inc 01-09-2002; Elsevier
• Subjects: Alkalosis - blood; Alkalosis - epidemiology; Alkalosis - etiology; Alkalosis - mortality; Bicarbonates - adverse effects; Bicarbonates - blood; Bicarbonates - metabolism; Biological and medical sciences; Carbon Dioxide - blood; carbon dioxide content; citrate; Citric Acid - administration & dosage; Citric Acid - adverse effects; Citric Acid - metabolism; Combined surgery. Multiple transplantations; Databases as Topic; Female; Humans; Hypokalemia - complications; Infusions, Intravenous; Intraoperative Care - methods; Kidney - physiology; Kidney - physiopathology; Kidney Function Tests; Liver Transplantation - adverse effects; Male; Medical sciences; metabolic alkalosis (MA); Middle Aged; Multivariate Analysis; Orthotopic liver transplantation (OLT); Predictive Value of Tests; Preoperative Care - methods; Prevalence; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Water-Electrolyte Balance; metabolic alkalosis (MA); citrate; Orthotopic liver transplantation (OLT); carbon dioxide content; Human; Metabolic alkalosis; Liver; Carbon dioxide; Prediction; Citrate; Transplantation; Acid base balance disorder; Homotransplantation; Surgery; Potassium; Mechanical ventilation; Comparative study; Quantitative analysis
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/ajkd.2002.34909

Background: Metabolic alkalosis (MA) is common after orthotopic liver transplantation (OLT). Methods: The study was conducted to identify factors associated with MA after 285 OLTs. MA, defined as total carbon dioxide content of 30 mEq/L or greater, developed in 115 patients (40%) within the first 3 postoperative days. Results: By univariate analysis, patients with MA had a greater preoperative carbon dioxide content (24.4 ± 3 versus 22.9 ± 2.9 mEq/L; P < 0.0001) and hematocrit (35% ± 5% versus 33% ± 6%; P < 0.02), but lower creatinine (0.9 ± 0.5 versus 1.2 ± 1.2 mg/dL; P < 0.001) and blood urea nitrogen levels (15 ± 12 versus 19 ± 17 mg/dL; P < 0.001) compared with controls. Patients with MA were administered more citrate intraoperatively compared with controls (6.2 ± 5.2 versus 4.5 ± 3.6 mEq/kg of body weight; P < 0.02). Patients with MA had a lower postoperative potassium level (3.7 ± 0.4 versus 4 ± 0.5 mEq/L; P < 0.0001) and cumulative fluid balance (−0.66 ± 1.87 versus +0.003 ± 3.9 L; P < 0.007) compared with controls. By multivariate analysis, preoperative carbon dioxide content (odds ratio, 1.19; 95% confidence interval [CI], 1.08 to 1.31 per mEq/L), creatinine level (odds ratio, 0.61; 95% CI, 0.39 to 0.96 per mg/dL), intraoperative administered citrate (odds ratio, 3.35; 95% CI, 1.71 to 6.53 per 10 mEq/kg body weight), and postoperative potassium level (odds ratio, 0.32; 95% CI, 0.18 to 0.57 per mEq/L) were independently associated with MA. MA was not associated with increased hospital mortality (7.8% versus 8.2%, MA versus controls). However, patients with MA spent more time on mechanical ventilation than controls (5 ± 0.8 versus 3 ± 0.6 days; P ≤ 0.03). Conclusion: Preoperative total carbon dioxide content, renal function, intraoperative administered citrate, and postoperative potassium level are independently associated with MA after primary OLT. © 2002 by the National Kidney Foundation, Inc.