Background: The best intraoperative hemodynamic strategy in liver transplantation remains uncertain. No high-quality clinical trials or observational studies have comprehensively assessed the association between intraoperative hemodynamic management and postoperative outcomes in liver transplantation. In this study, we aimed to measure the association between two key components of intraoperative hemodynamic management, fluid balance and vasopressor doses, and 7-day graft dysfunction or non-function and other postoperative complications following liver transplantation. Methods: We conducted a multicenter cohort study across 8 liver transplantation centers in Canada and France. We included consecutive liver transplant recipients over at least 1-year between January 2021 and May 2023. Our exposures were intraoperative fluid balance (volume of blood products, transfused cell saver, colloids, and crystalloids (divided by 1.5), minus estimated blood loss, expressed in liters) and intraoperative vasopressor doses (expressed in increments of 25 µg/kg norepinephrine equivalents). Our primary outcome was 7-day early allograft dysfunction or primary graft non-function. We used regression models adjusted for confounders, including intraoperative hypotension. Results: We included 852 liver transplant recipients (836 with complete data). Participants had a mean (standard deviation) age of 54 years (12), and a median quartiles MELD 3.0 score of 20 11, 29. The incidence of 7-day early allograft dysfunction or primary graft non-function was 28% (occurring in 236 patients). Neither fluid balance (RR = 1.02 95% CI, 0.97 to 1.06 for each liter of fluid balance) nor vasopressor doses (RR = 1.03 95% CI, 0.99 to 1.06 for each increment of 25 ug/kg of norepinephrine equivalent) were associated with the risk of this outcome. Conclusion: A higher fluid balance and higher doses of vasopressors were not associated with a higher risk of 7-day early allograft dysfunction or primary graft non-function after liver transplantation.
Carrier et al. (Mon,) studied this question.