{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:02:39Z","timestamp":1791252159923,"version":"4.1.0"},"reference-count":68,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"vor","delay-in-days":69,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fluid management practices during and after liver transplantation vary widely among centers despite better understanding of the pathophysiology of end\u2010stage liver disease and of the effects of commonly used fluids. This reflects a lack of high quality trials in this setting, but also provides a rationale for both systematic review of all relevant studies in liver recipients and evaluation of new evidence from closely related domains, including hepatology, non\u2010transplant abdominal surgery, and critical care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To develop evidence\u2010based recommendations for perioperative fluid management to optimize immediate and short\u2010term outcomes following liver transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Studies included those evaluating the following postoperative outcomes: acute kidney injury, respiratory complications, operative blood loss\/red cell units required, and intensive care length of stay.<\/jats:p><jats:p>PROSPERO protocol ID: CRD42021241392<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following expert panel review, 18 of 1624 screened studies met eligibility criteria for inclusion in the final quantitative synthesis. These included six single center RCTs, 11 single center observational studies, and one observational study comparing centers with different fluid management techniques. Definitions of interventions and outcomes varied between studies. Recommendations are therefore based substantially on expert opinion and evidence from other clinical settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A moderately restrictive or \u201creplacement only\u201d fluid regime is recommended, especially during the dissection phase of the transplant procedure. Sustained hypervolemia, based on absence of fluid responsiveness, elevated filling pressures and\/or echocardiographic findings, should be avoided <jats:italic>(Quality of Evidence<\/jats:italic>: Moderate | <jats:italic>Grade of Recommendation<\/jats:italic>: Weak for restrictive fluid regime. Strong for avoidance of hypervolemia). Mean Arterial Pressure (MAP) should be maintained at &gt;60\u201365 mmHg in all cases <jats:italic>(Quality of Evidence<\/jats:italic>: Low | <jats:italic>Grade of Recommendation<\/jats:italic>: Strong). There is insufficient evidence in this population to support preferential use of any specific colloid or crystalloid for routine volume replacement. However, we recommend against the use of 130\/.4 HES given the high incidence of AKI in this population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14651","type":"journal-article","created":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T09:14:46Z","timestamp":1647681286000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Perioperative fluid management and outcomes in adult deceased donor liver transplantation \u2013 A systematic review of the literature and expert panel recommendations"],"prefix":"10.1111","volume":"36","author":[{"given":"Clare M.","family":"Morkane","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine Kings College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Sapisochin","sequence":"additional","affiliation":[{"name":"Multio\u2010Organ Transplant &amp; HPB Surgical Oncology Division of General Surgery University Health Network University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Mukhtar","sequence":"additional","affiliation":[{"name":"Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen M. 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M.","family":"Reyntjens","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Rijksuniversiteit University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gebhard","family":"Wagener","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Columbia University Medical Center  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Spiro","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine Royal Free Hospital  London UK"},{"name":"Division of Surgery &amp; Interventional Science University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri A.","family":"Raptis","sequence":"additional","affiliation":[{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"},{"name":"Division of Surgery &amp; 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