Mannitol for Prevention of Acute Kidney Injury After Liver Transplantation

A Randomized Controlled Trial

Moataz Maher Emara; Doaa Galal Diab; Amr Mohamed Yassen; Maha A. Abo-Zeid

BMC Anesthesiol. 2022;22(393)

Sample Size Calculation

A pilot study was performed using the control [saline (S)] group and found a 60% incidence rate of early AKI within 48 h of LDLT. About 39 patients were required in each group to demonstrate an absolute 50% decrease in the incidence rate of AKI after using mannitol assuming α = 0.05 and β = 0.2 (80% power) and using the chi-squared test. A total of 42 patients were required in each group to allow for subject dropout.

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Table 1. Liver transplantation recipients' baseline characteristics and preoperative laboratory results
	Group (M) N = 39	Group S N = 41	P-Value
Age (years)	53 (43–57)	54 (45–57)	0.858
Sex (Male/Female No., %)	27/12 (69.2/30.8%)	29/12 (70.7/39.3%)	0.884
Weight (Kg)	77.62 (10.7)	78.59 (10.9)	0.69
Height (m)	1.68 (0.08)	1.68 (0.07)	0.893
Body Surface Area (m²)	1.87 (0.15)	1.88 (0.02)	0.645
MELD score	15 (12–17)	15 (11–17)	0.703
CPC	8 (7–10)	8 (6–10)	0.873
Etiology (No., %)
Viral hepatitis	19/39 (48.7%)	15/41 (36.6%)	0.445
Hepatocellular carcinoma	12/39 (30.8%)	19/41 (46.3%)
Autoimmune disease	7/39 (17.9%)	5/41 (12.2%
Cryptogenic	1/39 (2.6%)	2/41 (4.9%)
Comorbidities (No., %)
HTN	0/39	1/41 (2.5%)	0.119
DM	10/39 (25.6%)	11/41 (27.5%)
DM and HTN	0/39	5/41 (12.5%)
Cardiac (mild mitral regurgitation)	0/39	1/41 (2.5%)
Hypothyroidism	1/39 (2.6%)	0/41
S.Cr. (mg/dL)	0.7 (0.6–0.8)	0.7 (0.6–0.9)	0.221
S. AST (u/mL)	40 (30–60)	48 (39–76)	0.068
S. ALT (u/mL)	21 (21–34)	27 (21–54)	0.35
S. total bilirubin (mg/dL)	2.3 (1.6–3.3)	1.9 (1.55–3.4)	0.765
S. direct bilirubin (mg/dL)	1 (0.6–1.5)	1.1 (0.55–1.8)	0.821
S. albumin (g/dL)	2.9 (0.68)	2.8 (0.53)	0.41
INR	1.5 (0.29)	1.46 (0.29)	0.577
CRP (mg/dL)	0 (0–8)	0 (0–9)	0.808

Data are presented as mean (SD) or median (IQR), and No. (%), SD standard deviation, IQR interquartile range, M group mannitol group, S group saline group, MELD model for end-stage liver disease, CPC Child-Pugh classification, HCC hepatocellular carcinoma, HTN hypertension, DM diabetes mellitus, INR international normalized ratio, AST Aspartate Transaminase, ALT Alanine Transaminase, S serum, Cr Creatinine, CRP C-reactive protein

Table 2. Intraoperative ischemia and anhepatic phase times, operative duration, intraoperative blood product transfusion, UO, and total doses of furosemide, norepinephrine, and epinephrine
	Group (M) N = 39	Group (S) N = 41	P-Value
Cold ischemia (minutes)	28.7 (10.5)	29.8 (9.9)	0.655
Warm ischemia (minutes)	35.8 (8.6)	38.4 (9.2)	0.2
Anhepatic phase duration (minutes)	70 (15.6)	73.6 (17.3)	0.348
Operative duration (minutes)	567.6 (70.4)	576 (78.2)	0.636
RBCs (No. of patients)	24/38 (63.2%)^#	28/41 (68.3%)	0.644
Fresh frozen plasma (No. of patients)	3/38 (7.9%)^#	5/41 (12.2%)	0.713
Platelets (No. of patients)	0/38	0/41	-
RBCs (No. of units)	1 (0–3.25)	2 (0–3.5)	0.695
Plasma (No. of units)	0 (0–7)	0 (0–5)	0.549
Anhepatic phase UO (mL)	350 (200–500)	150 (50–325)	0.003*
Total UO (mL)	2100 (1340–3350)	1400 (1025–2425)	0.027*
Total intraoperative furosemide (mg)	5 (0–10)	5 (0–10)	0.528
Total intraoperative norepinephrine (mcg)	200 (77.5–275)	190 (120–270)	0.97
Total intraoperative epinephrine (mcg)	0 (0–25)	0 (0–20)	0.35

Data are presented as mean (SD), median, (IQR) or No. (%). * Indicates statistical significance (P-value <0.05), M group mannitol group, S group saline group, UO urine output, RBCs Red blood cells
#missed data of one patient

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Mannitol for Prevention of Acute Kidney Injury After Liver Transplantation

A Randomized Controlled Trial

Sample Size Calculation

Tables

Tables

References

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Authors and Disclosures

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