Sodium bicarbonate infusion in patients undergoing orthotopic liver transplantation: A single center randomized controlled pilot trial

Laurence Weinberg, Jeremy Broad, Param Pillai, Guangjun Chen, Micheline Nguyen, Glenn M. Eastwood, Nick Scurrah, Mehrdad Nikfarjam, David Story, Larry Mcnicol, Rinaldo Bellomo

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4 Citations (Scopus)

Abstract

Background: Liver transplantation-associated acute kidney injury (AKI) carries significant morbidity and mortality. We hypothesized that sodium bicarbonate would reduce the incidence and/or severity of liver transplantation-associated AKI. Methods: In this double-blinded pilot RCT, adult patients undergoing orthotopic liver transplantation were randomized to an infusion of either 8.4% sodium bicarbonate (0.5 mEq/kg/h for the first hour; 0.15 mEq/kg/h until completion of surgery); (n = 30) or 0.9% sodium chloride (n = 30). Primary outcome: AKI within the first 48 h post-operatively. Results: There were no significant differences between the two treatment groups with regard to baseline characteristics, model for end-stage liver disease and acute physiology and chronic health evaluation (APACHE) II scores, and pre-transplantation renal function. Intra-operative factors were similar for duration of surgery, blood product requirements, crystalloid and colloid volumes infused and requirements for vasoactive therapy. Eleven patients (37%) in the bicarbonate group and 10 patients (33%) in the sodium chloride group developed a post-operative AKI (p = 0.79). Bicarbonate infusion attenuated the degree of immediate post-operative metabolic acidosis; however, this effect dissipated by 48 h. There were no significant differences in ventilation hours, ICU or hospital length of stay, or mortality. Conclusions: The intra-operative infusion of sodium bicarbonate did not decrease the incidence of AKI in patients following orthotopic liver transplantation.

Original languageEnglish
Pages (from-to)556-565
Number of pages10
JournalClinical Transplantation
Volume30
Issue number5
DOIs
Publication statusPublished - May 2016

Keywords

  • Bicarbonate
  • Kidney injury
  • Liver transplantation

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