Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases.

OBJECTIVES Low central venous pressure (LCVP)-assisted hepatectomy is associated with decreased blood loss and lower transfusion rates. Concerns about its impact on renal function have prevented widespread application. This study was conducted to review the dynamics of renal function after LCVP-assisted hepatectomy. METHODS A retrospective analysis of a prospective surgical database was carried out. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The RIFLE (risk-injury-failure-loss-end-stage) criteria were used to define postoperative biochemical acute kidney injury (bAKI). Occurrences of clinically relevant AKI (cAKI) were identified in the study center postoperative database. RESULTS During the period 2003-2012, 2116 LCVP-assisted hepatectomies were performed. The median patient age was 61 years [interquartile range (IQR): 51-70 years] and 51% of patients were male. The median number of resected segments was two; resections involved from one to four segments. Median estimated blood loss was 300 ml (IQR: 200-600 ml). Rates of morbidity and 90-day mortality were 21% and 2%, respectively. Low baseline eGFR (<90 ml/min) was seen in 84% of patients; 29% of patients had eGFR of <30 ml/min. Postoperative bAKI was seen in 17% (n = 350) of patients. Biochemical AKI with low eGFR was seen in 336 patients, representing 16% of the whole cohort; 13% of patients had been at risk, 2% experienced injury and 1% experienced failure. Kidney function had normalized at discharge in 159 of these patients. Nine patients (<1%) developed postoperative cAKI. CONCLUSIONS The majority of patients in the study cohort had low baseline eGFR. Biochemical alterations in eGFR are transient in the vast majority of patients after LCVP-assisted hepatectomy and their clinical impact is limited. The present data suggest that clinically relevant renal dysfunction is a very uncommon event in patients undergoing LCVP-assisted liver resection.

[1]  Zhi-jie Lu,et al.  Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy. , 2014, World journal of gastroenterology.

[2]  P. Efron,et al.  National Surgical Quality Improvement Program Underestimates the Risk Associated With Mild and Moderate Postoperative Acute Kidney Injury , 2013, Critical care medicine.

[3]  M. Gönen,et al.  Selecting patients for acute normovolemic hemodilution during hepatic resection: a prospective randomized evaluation of nomogram-based allocation. , 2013, Journal of the American College of Surgeons.

[4]  A. Levin,et al.  Practice Guideline , 2020, Encyclopedia of Behavioral Medicine.

[5]  M. Gonen,et al.  Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases , 2013, Annals of Surgical Oncology.

[6]  B. Bein,et al.  Effects of Low Central Venous Pressure During Preanhepatic Phase on Blood Loss and Liver and Renal Function in Liver Transplantation , 2010, World Journal of Surgery.

[7]  C. Schmid,et al.  A new equation to estimate glomerular filtration rate. , 2009, Annals of internal medicine.

[8]  M. Gonen,et al.  Operative Blood Loss Independently Predicts Recurrence and Survival After Resection of Hepatocellular Carcinoma , 2009, Annals of surgery.

[9]  M. Gonen,et al.  A Prospective Randomized Trial of Acute Normovolemic Hemodilution Compared to Standard Intraoperative Management in Patients Undergoing Major Hepatic Resection , 2008, Annals of surgery.

[10]  M. Gonen,et al.  Effect of Postoperative Morbidity on Long-term Survival After Hepatic Resection for Metastatic Colorectal Cancer , 2008, Annals of surgery.

[11]  W. Henderson,et al.  Morbidity and mortality after liver resection: results of the patient safety in surgery study. , 2007, Journal of the American College of Surgeons.

[12]  P. Allen,et al.  Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. , 2007, Journal of the American College of Surgeons.

[13]  L. Hann,et al.  Surgical and Radiologic Anatomy of the Liver, Biliary Tract, and Pancreas , 2007 .

[14]  Xiao‐Yu Yin,et al.  Low central venous pressure reduces blood loss in hepatectomy. , 2006, World journal of gastroenterology.

[15]  J. Sear.  Kidney dysfunction in the postoperative period. , 2005, British journal of anaesthesia.

[16]  R. Bellomo,et al.  Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group , 2004, Critical care.

[17]  M. Gonen,et al.  Influence of Transfusions on Perioperative and Long-Term Outcome in Patients Following Hepatic Resection for Colorectal Metastases , 2003, Annals of surgery.

[18]  John A. Cowan,et al.  Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. , 2003, Archives of surgery.

[19]  Yuman Fong,et al.  Improvement in Perioperative Outcome After Hepatic Resection: Analysis of 1,803 Consecutive Cases Over the Past Decade , 2002, Annals of surgery.

[20]  Y. G. Kim,et al.  Impaired angiogenesis in the aging kidney: vascular endothelial growth factor and thrombospondin-1 in renal disease. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[21]  W. White,et al.  Acute renal failure following cardiac surgery. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  J. Melendez,et al.  Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. , 1998, Journal of the American College of Surgeons.

[23]  K. Hardy,et al.  Central venous pressure and its effect on blood loss during liver resection , 1998, The British journal of surgery.

[24]  E. Cook,et al.  Preoperative renal risk stratification. , 1997, Circulation.

[25]  S Bygrave,et al.  One hundred and fifty hepatic resections: Evolution of technique towards bloodless surgery , 1996, The British journal of surgery.

[26]  J. Melendez,et al.  One hundred consecutive hepatic resections. Blood loss, transfusion, and operative technique. , 1994, Archives of surgery.

[27]  A. Nakao,et al.  Hepatic resection for hepatocellular carcinoma. , 1997, American journal of surgery.

[28]  N. Nagasue,et al.  Clinical experience with 118 hepatic resections for hepatocellular carcinoma. , 1986, Surgery.

[29]  Ding‐Shinn Chen,et al.  Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma. , 1986, Surgery.

[30]  J. Foster,et al.  Solid liver tumors. , 1977, Major problems in clinical surgery.