3092fa7965917b3d1d4c13098f42dcf2 jcm-15-04010.pdf 33025da5d41f80b2fb3e0a20e702c76c8cae05d2 jcm-15-04010.pdf ee59d83aa54aac34a1451d63dd0c5fede16734a24c0395ef7f1f5d1346d2b6e7 jcm-15-04010.pdf Title: Persistent Intraoperative Shock and Acute Kidney Injury After Liver Transplantation Subject: Background/Objectives: Acute kidney injury (AKI) is a common complication after liver transplantation. Although intraoperative hypotension has been associated with its development, the impact of shock persistence and its hemodynamic profile remains poorly defined. Methods: This was a single-center retrospective observational study including 226 adult patients undergoing liver transplantation. Intraoperative shock was defined as a mean arterial pressure < 60 mmHg or a 30% decrease from baseline and was classified as hypovolemic, distributive, cardiogenic, or mixed based on pulmonary artery catheter data. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria within the first 7 postoperative days. Associations were assessed using adjusted logistic regression models. Results: Intraoperative shock occurred in 35.8% of patients, and the incidence of AKI was 52.2%. The presence of shock was not independently associated with AKI (adjusted OR 1.66; 95% CI 0.94–2.95). However, shock occurring in multiple phases of the procedure was associated with a higher incidence of AKI (81.8% vs. 50%; p = 0.010), greater severity, and higher mortality (27.3% vs. 3.4%; p = 0.002). In exploratory analyses, mixed shock was associated with an increased need for renal replacement therapy within 30 days (p = 0.006), persistent renal dysfunction at day 30 (p = 0.048), and higher mortality (p = 0.01), while hypovolemic shock was associated with moderate AKI (OR 6.60; p = 0.011). Conclusions: The presence of intraoperative shock alone is not independently associated with AKI. In contrast, its persistence is strongly associated with AKI development and worse clinical outcomes.20pt Keywords: liver transplantation; acute kidney injury; intraoperative shock; shock persistence; hemodynamic phenotype Author: Susana González-Suárez, Laura Llinares Espí, Manuel Grande Fernández, Juan José Ciudad Morales, Arantxa Vaque Cabeza, Clemente Antonio Durán Feliu, Paloma María Pereira Ricart, Lluís Castells Fuste and Gonzalo Sapisochin Cantis Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Fri May 22 11:58:47 2026 CEST ModDate: Fri May 22 12:02:53 2026 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 863141 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- CYNOYG+CMSY10 Type 1 Builtin yes yes yes 123 0 NCGCKR+URWPalladioL-Ital Type 1 Custom yes yes yes 124 0 HCSVEL+URWPalladioL-Bold Type 1 Custom yes yes yes 125 0 AIRHKL+VnURWPalladioL Type 1 Custom yes yes yes 126 0 SVEBEJ+URWPalladioL-Roma Type 1 Custom yes yes yes 127 0 RFECCF+EURM10 Type 1 Builtin yes yes yes 203 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 219 0 AMEMEN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 230 0 AMEMEL+PalatinoLinotype TrueType WinAnsi yes yes no 231 0 AMEMEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 232 0 AMEMEN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 239 0 AMEMEL+PalatinoLinotype TrueType WinAnsi yes yes no 240 0 AMEMEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 241 0 AMEMEL+PalatinoLinotype TrueType WinAnsi yes yes no 274 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-07-09 03:57:29 CEST RepresentationInformation: jcm-15-04010.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-07-08 10:38:47 CEST Size: 863141 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 409 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Study Design Item: Title: Study Population Item: Title: Anesthetic Management and Monitoring Item: Title: Definition of Intraoperative Shock and Hemodynamic Classification Item: Title: Definition of Shock Persistence Item: Title: Definition of Acute Kidney Injury Item: Title: Data Collection and Outcome Definitions Item: Title: Statistical Analysis Item: Title: Results Children: Item: Title: Cohort Characteristics Item: Title: Intraoperative Shock Persistence and AKI Item: Title: Presence of Intraoperative Shock and AKI Item: Title: Hemodynamic Profile of Shock and AKI Item: Title: Renal Outcomes According to Shock Type Item: Title: Clinical Outcomes According to Shock Type Item: Title: Discussion Item: Title: Conclusions Item: Title: References Info: Title: Persistent Intraoperative Shock and Acute Kidney Injury After Liver Transplantation Author: Susana González-Suárez, Laura Llinares Espí, Manuel Grande Fernández, Juan José Ciudad Morales, Arantxa Vaque Cabeza, Clemente Antonio Durán Feliu, Paloma María Pereira Ricart, Lluís Castells Fuste and Gonzalo Sapisochin Cantis Subject: Background/Objectives: Acute kidney injury (AKI) is a common complication after liver transplantation. Although intraoperative hypotension has been associated with its development, the impact of shock persistence and its hemodynamic profile remains poorly defined. Methods: This was a single-center retrospective observational study including 226 adult patients undergoing liver transplantation. Intraoperative shock was defined as a mean arterial pressure < 60 mmHg or a 30% decrease from baseline and was classified as hypovolemic, distributive, cardiogenic, or mixed based on pulmonary artery catheter data. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria within the first 7 postoperative days. Associations were assessed using adjusted logistic regression models. Results: Intraoperative shock occurred in 35.8% of patients, and the incidence of AKI was 52.2%. The presence of shock was not independently associated with AKI (adjusted OR 1.66; 95% CI 0.94–2.95). However, shock occurring in multiple phases of the procedure was associated with a higher incidence of AKI (81.8% vs. 50%; p = 0.010), greater severity, and higher mortality (27.3% vs. 3.4%; p = 0.002). In exploratory analyses, mixed shock was associated with an increased need for renal replacement therapy within 30 days (p = 0.006), persistent renal dysfunction at day 30 (p = 0.048), and higher mortality (p = 0.01), while hypovolemic shock was associated with moderate AKI (OR 6.60; p = 0.011). Conclusions: The presence of intraoperative shock alone is not independently associated with AKI. 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