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This research investigates how postoperative fluid balance affects liver function recovery and renal therapy needs after liver transplantation.

April 15, 2026European journal of medical research0 citationsOpen Access

The impact of postoperative fluid balance on early hepatic function and renal replacement therapy requirement after liver transplantation: a single-center retrospective cohort study

STShenghai TanFirst Affiliated Hospital of Xi'an Jiaotong University SLSinan LiuFirst Affiliated Hospital of Xi'an Jiaotong University SXSha XuFirst Affiliated Hospital of Xi'an Jiaotong University

Key Points

This research investigates how postoperative fluid balance affects liver function recovery and renal therapy needs after liver transplantation.
Conducted a retrospective cohort study on 511 liver transplantation patients
Grouped participants by 5-day postoperative cumulative fluid balance
Utilized propensity score matching to create balanced groups
Compared liver and renal function indices, RRT rates, and AKI incidence
Applied multivariate logistic regression and RCS analysis to identify RRT risk factors
Negative fluid balance group showed lower serum creatinine levels and a 6.3% RRT rate compared to 18.8% in positive group (p = 0.017)
No significant differences in liver function indices (AST, ALT, T-Bil) between groups
Surgical duration, postoperative day 1 ALT, and fluid balance increase are identified as independent RRT risk factors
RCS analysis confirmed the correlation between increased fluid balance and higher RRT risk

Abstract

Liver transplantation (LT) is the definitive treatment for end-stage liver disease, with acute kidney injury (AKI) and renal replacement therapy (RRT) as common severe early complications. Fluid overload (FB) is a key risk factor for renal adverse events, yet the impact of postoperative fluid balance on early liver function recovery and renal outcomes after LT remains to be clarified. A single-center retrospective cohort study was conducted on 511 LT patients (2022–2025), grouped by 5-day postoperative cumulative fluid balance (negative/positive). Propensity score matching (1:1, n = 160) was used to balance baselines. Liver/renal function indices, RRT rate and AKI incidence were compared between groups. Multivariate logistic regression and restricted cubic spline (RCS) analysis were applied to identify RRT risk factors and explore the association between fluid balance and RRT risk. No significant differences in aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (T-Bil) were observed between groups at postoperative days 1, 3 and 5. The negative fluid balance group had lower serum creatinine (Scr) levels, faster Scr decline, and a significantly lower RRT rate (6.3% vs. 18.8%, p = 0.017) than the positive group. Surgical duration (OR = 2.272, p = 0.009), postoperative day 1 ALT (100-unit increase, OR = 1.111, p = 0.006) and fluid balance (1-L increase, OR = 1.125, p = 0.028) were independent RRT risk factors. RCS analysis confirmed increased fluid balance correlated with higher RRT risk. Postoperative fluid balance has no effect on early liver function recovery after LT, while cumulative positive fluid balance is associated with elevated RRT requirement. Surgical duration, postoperative day 1 ALT and fluid balance are independent risk factors for early RRT, highlighting the importance of optimized early fluid management for preventing renal adverse events after LT.

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