Dataset Information

Mannitol for prevention of acute kidney injury after liver transplantation: a randomized controlled trial.

ABSTRACT:

Background

Acute kidney injury (AKI) is a common complication after liver transplantation, which is associated with increased morbidity and mortality. Therefore, this study investigated mannitol as an oxygen-free radical scavenger and its role in the prevention of early AKI after living donor liver transplantation (LDLT).

Methods

A total of 84 adult patients who underwent LDLT were randomly assigned to two equal groups: the M group, where patients received 1 g/kg mannitol 20%, or the S group, where patients received an equal volume of saline. The primary outcome was the incidence of early AKI, defined as a 0.3 mg/dl increase in the serum creatinine 48 h postoperatively. Laboratory assessments of the graft and creatinine were recorded until 3 months after transplantation besides the post-reperfusion syndrome and the intraoperative hemodynamic measurements.

Results

The AKI incidence was comparable between groups (relative risk ratio of 1.285, 95% CI 0.598-2.759, P = 0.518). Moreover, AKI stages and serum creatinine 3 months after transplantation, P = 0.23 and P = 0.25, respectively. The incidence of the post-reperfusion syndrome was comparable in both groups, 29/39 (74.4%) and 31/41 (75.6%) in M and S groups, respectively, P = 0.897. The intraoperative hemodynamic parameters showed no significant difference between groups using the area under the curve.

Conclusion

The current LDLT recipient sample was insufficient to demonstrate that pre-reperfusion 1 g/kg mannitol infusion would reduce the risk of early AKI or post-reperfusion syndrome.

Clinical trial registration number

Pan African Clinical Trials Registry (PACTR202203622900599); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=21511 .

SUBMITTER: Emara MM

PROVIDER: S-EPMC9762035 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Mannitol for prevention of acute kidney injury after liver transplantation: a randomized controlled trial.

Emara Moataz Maher MM Diab Doaa Galal DG Yassen Amr Mohamed AM Abo-Zeid Maha A MA

BMC anesthesiology 20221219 1

<h4>Background</h4>Acute kidney injury (AKI) is a common complication after liver transplantation, which is associated with increased morbidity and mortality. Therefore, this study investigated mannitol as an oxygen-free radical scavenger and its role in the prevention of early AKI after living donor liver transplantation (LDLT).<h4>Methods</h4>A total of 84 adult patients who underwent LDLT were randomly assigned to two equal groups: the M group, where patients received 1 g/kg mannitol 20%, or ...[more]

PMID: 36536282

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Project description:Rationale & objectiveIntradialytic hypotension (IDH) is a common complication at the initiation of hemodialysis (HD) therapy, is associated with greater mortality, and may be related to relatively rapid shifts in plasma osmolality. This study sought to evaluate the effect of an intervention to minimize intradialytic changes in plasma osmolality on the occurrence of IDH.Study designDouble-blind, single-center, randomized, controlled trial.Setting & participantsIndividuals requiring initiation of HD for acute or chronic kidney disease.InterventionMannitol, 0.25g/kg/h, versus a similar volume of 0.9% saline solution during the first 3 HD sessions.OutcomesThe primary end point was average decline in systolic blood pressure (SBP). The secondary end point was the proportion of total sessions complicated by IDH (defined as a decrease ≥ 20mm Hg from the pre-HD SBP). Exploratory end points included biomarkers of cardiac and kidney injury.Results52 patients were randomly assigned and contributed to 156 study visits. There were no significant differences in average SBP decline between the mannitol and placebo groups (15±11 vs 19±16mm Hg; P = 0.3). The proportion of total sessions complicated by IDH was lower in the mannitol group compared to placebo (25% vs 43%), with a nominally lower risk for developing an episode of IDH (OR, 0.38; 95% CI, 0.14-1.00), though this finding was of borderline statistical significance (P = 0.05). There were no consistent differences in cardiac and kidney injury biomarker levels between treatment groups.LimitationsModest sample size and number of events.ConclusionsIn this pilot randomized controlled trial studying patients requiring initiation of HD, we found no difference in absolute SBP decline between those who received mannitol and those who received saline solution. However, there were fewer overall IDH events and a nominally lower risk for dialysis sessions being complicated by IDH in the mannitol group. A larger multicenter randomized controlled trial is warranted.FundingGovernment funding to an author (Dr Mc Causland is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant K23DK102511).Trial registrationRegistered at ClinicalTrials.gov with study number NCT01520207.

Dataset Information

Mannitol for prevention of acute kidney injury after liver transplantation: a randomized controlled trial.

Background

Methods

Results

Conclusion

Clinical trial registration number

Publications

Mannitol for prevention of acute kidney injury after liver transplantation: a randomized controlled trial.

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