Is There a Relationship Between Intraoperative Hemodynamic Instability and Calcineurin Inhibitor-Related Toxicity, Early After Liver Transplantation? A Single-Center Observational Study

This study evaluated the relationship between intraoperative hemodynamic instability (IOHI) and the development of calcineurin inhibitor (CNI) toxicity in the early postoperative period after liver transplantation (LT). Eighty-two patients were enrolled during a 1-year period and a 3-month follow-up. IOHI, requiring continuous infusion of vasopressors, was observed in 31 patients (38\%, group 1; control group 2, n = 51). Acute kidney injury (AKI) developed in 28 patients (52\% in group 1 vs 24\% in group 2, P = .02), and CNI-related neurotoxicity (CNI-NT) in 26 (48\% in group 1 vs 22\% in group 2, P = .03). Group 1 patients received mainly deceased donor grafts (87\% vs 57\% in group 2, P < .001). An independent association between IOHI and CNI-NT (P = .029) and AKI (P = .016) was observed. The receiver-operator characteristic curve revealed an area under the curve of 0.63 for IHI (sensitivity 56\%; specificity 75\%) and 0.65 for AKI (sensitivity 56\%; specificity 70.2\%). In conclusion, patients undergoing LT with IOHI may be more prone to developing CNI-NT and AKI in the early postoperative period.