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

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.