Perioperative Albumin vs. HES Products in Orthotopic Liver Transplant.: Abstract# C2001

Background: Fluid resuscitation intra‐ and post‐operatively during liver transplant (OLT) may play a significant role in determining the incidence of acute kidney injury (AKI). Our recent internal intraoperative data in OLT and published studies in the non‐OLT critically ill suggests that recipients of 6% hydroxyethyl starch (HES) (130/0.4) products may experience higher rates of AKI. This study aimed to evaluate the association between postoperative HES administration and renal outcomes during the immediate post‐transplant period in OLT. Methods: This was a retrospective cross‐sectional analysis of OLT patients grouped based on whether they received HES postoperatively. AKI was defined according to the RIFLE criteria as Risk, Injury, and Failure based on the change in creatinine from preoperative baseline to peak level by postoperative day 7. Categorical data were evaluated using Chi‐square analysis, and independent sample t‐tests were employed for continuous data. Results: 185 patients underwent OLT during the study period and were included for analysis; patients who received combined liver‐kidney transplants and those who did not receive colloid were excluded. 34 patients received HES products postoperatively. Baseline demographics were similar between groups. There was no difference in the incidence of RIFLE injury or RIFLE failure (34% vs. 34%; 24% vs. 15% p>0.05). However, patients receiving HES products were receiving dialysis (HD or CRRT) at a higher rate during the first 30 days (21% vs. 5%; p=0.003). Conclusions: While our internal data for intraoperative HES usage aligns with recent critical care literature regarding an increased risk of renal dysfunction, the usage of HES in the immediate postoperative setting was not associated with more frequent RIFLE‐defined AKI. HES was utilized more often in patients receiving dialysis; further analyses are required to determine causality.