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Postoperative intra-abdominal pressure and renal function after liver transplantation
Gianni Biancofiore1, Maria L Bindi, Anna M Romanelli
1Post-surgical and Transplant Intensive Care Unit, Azienda Ospedaliera Pisana, Pisa, Italy. g.biancofiore@med.unipi.it
Hypothesis:
Intra-abdominal hypertension frequently threatens renal function early after orthotopic liver transplantation (OLT).
Design:
A prospective study of consecutive patients who underwent OLT.
Setting:
The intensive care unit of a National Health Service teaching hospital.
Patients And Main Outcome Measures:
The intra-abdominal pressure (IAP) of 108 consecutive patients who underwent OLT was postoperatively measured 3 times a day for 72 hours using the urinary bladder technique. Intra-abdominal hypertension was defined as an IAP of 25 mm Hg or higher.
Results:
Thirty-four patients (31%) had a high IAP. Acute renal failure developed in 17 recipients (16%), 11 (65%) of whom had intra-abdominal hypertension (P<.01), with a mean +/- SD IAP of 27.9 +/- 9.9 mm Hg vs 18.6 +/- 5.2 mm Hg in those without acute renal failure (P<.001). The subjects with a high IAP were more frequently administered loop diuretics to maintain adequate diuresis (P<.001) and had a low mean arterial pressure on the day of surgery (P<.01), despite the fact that they were given more intravenous fluids (P<.01) and did not differ in the need for inotropic drugs. Logistic regression analysis showed that intraoperative transfusions of more than 15 U, respiratory failure, and intra-abdominal hypertension (P<.01) were independent risk factors for renal failure. The length of intensive care unit stay was similar in the patients with a normal and a high IAP, but mortality was higher among the latter (P =.02).
Conclusions:
Intra-abdominal hypertension is common after OLT and is significantly associated with renal failure, reduced urinary output, and intensive care unit mortality. It is, therefore, worth monitoring IAP in those undergoing OLT.