• Laurence Weinberg, Jeremy Broad, Param Pillai, Guangjun Chen, Micheline Nguyen, Glenn M Eastwood, Nick Scurrah, Mehrdad Nikfarjam, David Story, Larry McNicol, and Rinaldo Bellomo.
• Department of Anesthesia, The University of Melbourne, Melbourne, Vic., Australia.
• Clin Transplant. 2016 May 1; 30 (5): 556-65.

BackgroundLiver 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.MethodsIn 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 OutcomeAKI within the first 48 h post-operatively.ResultsThere 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.ConclusionsThe intra-operative infusion of sodium bicarbonate did not decrease the incidence of AKI in patients following orthotopic liver transplantation.© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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