Evidence map›Paper›PMID 41324145›Full record

ArticlePaediatric anaesthesia2026

Associations of Intraoperative Hypotension and Vasopressor Administration With Postoperative Acute Kidney Injury in Children Undergoing Liver Transplantation: A Retrospective Cohort Study.

Theodora Wingert, Kelly Feldman, Tiffany Williams, Amelie Delaporte, Matthew Lum, Tristan Grogan, Christine Nguyen-Buckley, Alexandre Joosten

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Article in Paediatric anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Theodora WingertDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA.ORCID 0000-0001-7149-9150
Kelly FeldmanDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA.
Tiffany WilliamsDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA.
Amelie DelaporteDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA.
Matthew LumDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA.
Tristan GroganDepartment of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Christine Nguyen-BuckleyDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA.
Alexandre JoostenDepartment of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBoth intraoperative hypotension (IOH) and vasopressor administration are independently associated with postoperative acute kidney injury (AKI) in adults undergoing major noncardiac surgery. Whether these associations extend to children undergoing major noncardiac surgery, such as liver transplantation, remains unknown.

aimsThis study aimed to evaluate whether IOH, defined as time spent with a mean arterial pressure (MAP) less than one standard deviation (SD) below age- and sex-adjusted normal, and vasopressor administration in children are associated with postoperative AKI in liver transplantation (LT). We hypothesized that both IOH and vasopressor use would be independent predictors of postoperative AKI after pediatric LT.

methodsThis single-center retrospective cohort study analyzed all patients < 18 years undergoing LT, excluding those with preoperative end-stage renal disease. The primary outcome was AKI, within 7 postoperative days defined according to KDIGO criteria. Multivariable logistic regression models were performed to determine whether IOH and vasopressor use, specifically maximum intraoperative epinephrine infusion, were independently associated with AKI. Exploratory K-means clustering was applied to IOH and vasopressor exposure to identify hemodynamic phenotypes, which were evaluated for associations with AKI and other outcomes.

resultsOf 144 pediatric LT cases, 22 were excluded for preexisting renal failure, leaving 122 for analyses. Postoperative AKI occurred in 39%. The mean cumulative duration MAP was < 1 standard deviation of age- and sex-adjusted mean was 26.6 versus 26.1 min, respectively, among patients who developed AKI versus those who did not (mean difference 0.52 min: 95% CI -15.03, 16.07, p = 0.948). In the multivariate analysis neither hypotension (by the same definition) nor maximum epinephrine appeared to be associated with AKI: adjusted odds ratio 1.003 (95% CI: 0.992-1.014) and 1.003 (95% CI: 0.994-1.012). Exploratory cluster analysis revealed distinct intraoperative hemodynamic phenotypes based on IOH and vasopressor use, which were significantly associated with some perioperative outcomes, highlighting the need for larger studies with more robust control of patient factors.

conclusionsIOH and vasopressor exposure were not independently associated with AKI in children undergoing LT.

Indexed as

Acute Kidney InjuryHypotensionIntraoperative ComplicationsLiver TransplantationPostoperative ComplicationsVasoconstrictor AgentsAdolescentChildChild, PreschoolCohort StudiesFemaleHumansInfantMaleRetrospective StudiesVasoconstrictor Agentsacute kidney injuryhypotensionliver transplantationpediatricpostoperative complicationsvasoconstrictor agents

Identifiers

PMID41324145
PMCPMC12887151

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.