Predictors of alkalosis after liver transplantation

Gabriel Contreras, Galo Garces, James Reich, Debasish Banerjee, Larry Young, Cynthia Cely, Florin Gadalean, Guido Perez, David Roth

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

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 [Cl], 1.08 to 1.31 per mEq/L), creatinine level (odds ratio, 0.61; 95% Cl, 0.39 to 0.96 per mg/dL), intraoperative administered citrate (odds ratio, 3.35; 95% Cl, 1.71 to 6.53 per 10 mEq/kg body weight), and postoperative potassium level (odds ratio, 0.32; 95% Cl, 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.

Original languageEnglish (US)
Pages (from-to)517-524
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume40
Issue number3
DOIs
StatePublished - Sep 2002

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Keywords

  • Carbon dioxide content
  • Citrate
  • Metabolic alkalosis (MA)
  • Orthotopic liver transplantation (OLT)

ASJC Scopus subject areas

  • Nephrology

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