The current study assessed 110 patients for eligibility; 26 patients were excluded. Subsequently, 84 patients assigned for LDLT surgery were randomized to receive either mannitol (Group M) or saline (Group S). Records of three patients in the M group and one patient in the S group were lost in the follow-up. Thus, the data of 39 patients in the M group and 41 patients in the S group were analyzed (Figure 1).
CONSORT Flow Chart
Recipients' characteristics and preoperative laboratory data of both groups showed no statistical differences (Table 1).
Regarding the donors' data, the mean age was 27 (6) in the M group and 27 (7) years in the S group (p-value = 0.625). There were 27 male donors (69.2%) in the M group and 29 (70.7%) in the S group (p-value = 0.884).
AKI Incidence and AKI Stages
The study's primary outcome was AKI incidence and was comparable between groups 11/39 (28.2%) in M and 9/41 (22%) in the S groups, respectively, (P = 0.518), with a relative risk ratio of 1.285, 95% CI 0.598–2.759.
Differences in AKI stages between groups are not statistically or clinically significant (P = 0.225). Zero cases in the M group versus two (4.9%) cases in the S group reached stage III AKI. About 15.4% (6/39) of those who received mannitol reached stage II when compared to 4.9% (2/41) in the S group, while five cases in each group had stage I AKI (12.8% in the M group and 12.2% in the S group).
Renal function was comparable in both groups at the 3 months post-LDLT (Supplementary Table 2). No case in the two groups needed dialysis during the study period (3 months post-LDLT) in this study.
At the six intraoperative measurement points, all intraoperative hemodynamic parameters including MAP, CO, SVR, and PVR in Figure 2 and PAOP, MPAP, and CVP in Supplementary Figure S1 showed no significant difference between the groups.
Intraoperative Hemodynamic parameters: A MAP = Mean arterial pressure MAP (mmHg); B CO = Cardiac Output (L/min); C SVR= Systemic vascular resistance (dyn/s/cm−5); D PVR = Pulmonary vascular resistance (dyn/s/cm−5) at 6 intraoperative measurement points: (1) immediately before skin incision, (2) the beginning of the an-hepatic (portal vein clamping), (3) 5-minutes before portal reperfusion (basal), (4) at 5-min after portal unclamping, (5) 5-minutes after hepatic arterial de- clamping and (6) at the skin closure. M group = mannitol group, S group =saline group. Data are presented as mean (SD)
Intraoperative serum K+ and ionized Ca+2 did not differ significantly between groups at all the six times of measurements. The average Na+ at 5 min before and after portal reperfusion was significantly higher in the S group (138 and 139 mEq/L) versus (133 and 135 mEq/L) in the M group [95% CI (2.7–7.4) and (1.4–6) mEq/L, respectively]. Moreover, Cl- on average was significantly higher in the S group 5 min before and 5 min after portal declamping, and 5 min after hepatic artery declamping (Figure 3).
Intraoperative electrolytes: A serum Sodium (mEq/L); B serum Potassium (mEq/L); C serum ionized calcium (mEq/L); D serum Chloride (mEq/L) at 6 intraoperative measurement points: (1) immediately before skin incision, (2) the beginning of the an-hepatic (portal vein clamping), (3) 5-minutes before portal reperfusion (basal), (4) at 5 min after portal unclamping, (5) 5-minutes after hepatic arterial de-clamping and (6) at the skin closure. M group = mannitol group, S group = saline group. Data are presented as mean (SD)
Other Operative Data and PRS
The PRS incidence was comparable in both groups, 29/39 (74.4%) and 31/41 (75.6%) in the M and S groups, respectively, P-value = 0.897.
Intraoperative UO was significantly higher in the M group compared to the S group during the anhepatic phase (350 (20–500) versus 150 (50–325) mL, respectively; 95% CI 66.5–235 L, P-value = 0.001) and the whole operative time 2100 (1340–3350) mL versus 1400 (1025–2425) mL respectively, P-value = 0.027; Table 2).
Cold ischemia, warm ischemia, anhepatic phase, and operative duration did not differ significantly between the two groups, as well as intraoperative blood products, transfusion, and total intraoperative consumption of furosemide, norepinephrine, and epinephrine doses (Table 2).
The pH, serum lactate, and LDH in the first two ICU days did not display significant variance between both groups as shown in Supplementary Table 1.
Supplementary Table 2 presents the quite similarities between both groups regarding Cr, AST, ALT, total bilirubin, albumin, and INR from the first postoperative day until 3 months post-transplant, except total bilirubin on the 7th day and albumin after 3 months, which were significantly higher in the M group with a median 4.7 mg/dl and 4.44 g/dL versus 2 and 4.21 in the S group, respectively.
Both groups were similar regarding the mean ICU stay duration, the incidence of postoperative surgical complications, and the 3-month survival period. Those values were 6.08 (1.98) days, 10 (25.6%), and 38 (97.4%) cases in the M group versus 5.54 (2) days, 7 (17.1%) and 37 (90.2%) cases in the S group with p-values of 0.228, 0.418, and 0.36, respectively.
BMC Anesthesiol. 2022;22(393) © 2022 BioMed Central, Ltd.