Fluid balance dynamics and early postoperative outcomes in orthotopic liver transplantation: a prospective cohort study

Introduction

This study evaluates the impact of Fluid Balance (FB) patterns on outcomes after Orthotopic Liver Transplantation (OLT). It hypothesizes that deviations from optimal FB increase morbidity.

Methods

In a single-center cohort post hoc analysis of 73 post-OLT patients, FB was categorized into three groups based on cumulative FB at 72 hours: Lowest (negative FB), Intermediate (0-2000 mL), and Highest (> 2000 mL). We analyzed Sequential Organ Failure Assessment (SOFA) scores, mortality rates, and causes of death. Logistic regression identified mortality predictors.

Results

The Highest FB group had the highest SOFA scores and mortality (Group “Lo”: 18.2%, Group “In”: 8.6%, Group “Hi”: 40.5%, p = 0.009). A U-shaped relationship between FB and hospital mortality was observed, with extremes of FB associated with higher mortality. Cumulative FB independently predicted all-cause mortality with a 29.5% increase in the risk of death. FB on day 3 also predicted all-cause mortality, increasing the risk by 83.9%. Furthermore, FB on day 1 was linked to a 134.5% increase in the risk of death due to primary non-function of the liver. SOFA_LIVER score strongly predicted all-cause mortality, with a one-point increase associated with a 98.8% to 114.7% increase in mortality risk.

Discussion

These findings suggest that both negative and positive extremes of FB are associated with worse outcomes after OLT, reinforcing the U-shaped relationship between FB and mortality. Our results underscore the importance of balanced fluid management, particularly in the early postoperative period. The study highlights the need for individualized FB strategies to optimize organ function and reduce mortality. The use of SOFA_LIVER scores as a predictor of mortality further emphasizes the importance of liver function monitoring in post-OLT patients. However, the single-centre design and convenience sample limit the generalizability of our findings, necessitating validation through multicenter studies.

Conclusion

Our study provides valuable insights into the relationship between FB patterns and mortality in OLT patients. Both negative and positive extremes of FB are associated with higher mortality, suggesting the need for a balanced and individualized fluid management approach. The strong predictive value of SOFA_LIVER scores for all-cause mortality highlights the importance of early and continuous monitoring of liver function. Future multicenter randomized controlled trials are needed to validate these findings and develop optimized fluid management protocols for OLT patients.