Bibliographic record
Abstract
In Brief Background: The best intraoperative hemodynamic strategy in liver transplantation remains uncertain. No high-quality clinical trials or observational studies have comprehensively assessed the association between intraoperative hemodynamic management and postoperative outcomes in liver transplantation. This study aimed to measure the association between two key components of intraoperative hemodynamic management, fluid balance and vasopressor doses, and 7-day graft dysfunction or nonfunction and other postoperative complications after liver transplantation. Methods: A multicenter cohort study was conducted across eight liver transplantation centers in Canada and France, including consecutive liver transplant recipients over at least 1 yr between January 2021 and May 2023. The exposures were intraoperative fluid balance (volume of blood products, transfused cell saver, colloids, and crystalloids (divided by 1.5), minus estimated blood loss, expressed in liters) and intraoperative vasopressor doses (expressed in increments of 25 μg/kg norepinephrine equivalents). The primary outcome was 7-day early allograft dysfunction or primary graft nonfunction. The study used regression models adjusted for confounders, including intraoperative hypotension. Results: A total of 852 liver transplant recipients (836 with complete data) were included. Participants had a mean ± SD age of 54 ± 12 yr and a median [quartile 1, quartile 3] Model for End-stage Liver Disease (MELD) 3.0 score of 20 [11, 29]. The incidence of 7-day early allograft dysfunction or primary graft nonfunction was 28% (occurring in 236 patients). Neither fluid balance (adjusted risk ratio = 1.02 [95% CI, 0.97 to 1.06] for each liter of fluid balance) nor vasopressor doses (adjusted risk ratio = 1.03 [95% CI, 0.99 to 1.06] for each increment of 25 μg/kg of norepinephrine equivalent) were associated with the risk of this outcome. Conclusions: A higher fluid balance and higher doses of vasopressors were not associated with a higher risk of 7-day early allograft dysfunction or primary graft nonfunction after liver transplantation. A total of 852 patients undergoing liver transplantation between 2021 and 2023 across eight centers in Canada and France were included in an observational causal inference analysis adjusting for patient, graft, procedure, and hemodynamic covariates. Neither fluid balance (adjusted risk ratio = 1.02 [95% CI, 0.97 to 1.06] for each liter of fluid balance) nor vasopressor doses (adjusted risk ratio = 1.03 [95% CI, 0.99 to 1.06] for each increment of 25 μg/kg norepinephrine of equivalent) were associated with the risk of 7-day early allograft dysfunction or primary graft nonfunction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".