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

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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
Pages (from-to)517-524
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume40
Issue number3
DOIs
StatePublished - Sep 1 2002

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Alkalosis
Liver Transplantation
Carbon Dioxide
Odds Ratio
Citric Acid
Creatinine
Potassium
Potassium Citrate
Body Weight
Water-Electrolyte Balance
Blood Urea Nitrogen
Hospital Mortality
Hematocrit
Artificial Respiration
Multivariate Analysis
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Nephrology

Cite this

Predictors of alkalosis after liver transplantation. / Contreras, Gabriel; Garces, Galo; Reich, James; Banerjee, Debasish; Young, Larry; Cely, Cynthia; Gadalean, Florin; Perez, Guido; Roth, David.

In: American Journal of Kidney Diseases, Vol. 40, No. 3, 01.09.2002, p. 517-524.

Research output: Contribution to journalArticle

Contreras, G, Garces, G, Reich, J, Banerjee, D, Young, L, Cely, C, Gadalean, F, Perez, G & Roth, D 2002, 'Predictors of alkalosis after liver transplantation', American Journal of Kidney Diseases, vol. 40, no. 3, pp. 517-524. https://doi.org/10.1053/ajkd.2002.34909
Contreras, Gabriel ; Garces, Galo ; Reich, James ; Banerjee, Debasish ; Young, Larry ; Cely, Cynthia ; Gadalean, Florin ; Perez, Guido ; Roth, David. / Predictors of alkalosis after liver transplantation. In: American Journal of Kidney Diseases. 2002 ; Vol. 40, No. 3. pp. 517-524.
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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.",
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T1 - Predictors of alkalosis after liver transplantation

AU - Contreras, Gabriel

AU - Garces, Galo

AU - Reich, James

AU - Banerjee, Debasish

AU - Young, Larry

AU - Cely, Cynthia

AU - Gadalean, Florin

AU - Perez, Guido

AU - Roth, David

PY - 2002/9/1

Y1 - 2002/9/1

N2 - 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.

AB - 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.

KW - Carbon dioxide content

KW - Citrate

KW - Metabolic alkalosis (MA)

KW - Orthotopic liver transplantation (OLT)

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