Bicarbonate Ringer’s solution could improve the intraoperative acid-base equilibrium and reduce hepatocellular enzyme levels after liver transplantation: A randomized controlled study

Background: Bicarbonate Ringer’s (BR) solution is a direct, liver and kidney metabolism-independent HCO 3− buffering system. We hypothesized that BR solution is more effective in acid-base equilibrium and more conducive to better liver function than acetate Ringer’s (AR) solution in liver transplantation (LT). Methods: Sixty-nine adult patients underwent orthotopic LT. Patients in the bicarbonate and acetate groups received BR and AR solutions, respectively. The primary outcome was the effect on pH and BE levels. The secondary outcome measures were the intraoperative 5% sodium bicarbonate infusion incidence and volume and liver and kidney function laboratory indicators. Results: The pH and absolute BE values changed significantly during the anhepatic stage and immediately after transplanted liver reperfusion in the bicarbonate group compared with the acetate group (all P  < 0.05). Five-percent sodium bicarbonate infusion incidence and volume were lower in the bicarbonate group than in the acetate group (all P  < 0.05). The postoperative 7-day AST level and 30-day creatine level were significantly higher in the acetate group than in the bicarbonate group (all P  < 0.05). Conclusion: Compared with AR solution, BR solution was associated with improved intraoperative acid-base balance, protected early postoperative liver graft function and reduced late-postoperative renal injury.