Intraoperative Management of Liver Transplant Patients Without the Routine Use of Renal Replacement Therapy. Issue 5 (May 2018)

• Record Type: Journal Article
• Authors: Adelmann, Dieter; Olmos, Andrea; Liu, Linda L.; Feiner, John R.; Roll, Garrett R.; Burdine, Lyle; Tavakol, Mehdi; Syed, Shareef; Orandi, Babak J.; Niemann, Claus U.
• Is Part Of: Transplantation. Volume 102:Issue 5(2018)
• Publication Date: 2018-05
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000002137
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Renal failure is common among patients undergoing liver transplantation. Liver allocation based on the model for end-stage liver disease score has increased the number of recipients who require perioperative renal replacement therapy (RRT). Although RRT can be continued intraoperatively, the risks and benefits of intraoperative RRT are not well defined. The aim of this study is to report the intraoperative management of patients with pretransplant renal failure at a transplant center with extremely infrequent utilization of intraoperative RRT. Materials and Methods: We performed a retrospective analysis of all adult patients undergoing orthotopic liver or simultaneous liver-kidney (SLK) transplantation between June 2009 and December 2015. Patients were divided into 2 groups based on their need for pretransplant RRT. Results: A total of 785 patients underwent liver or SLK transplant during the study period. One hundred and seventy-four patients (22.2%) required preoperative dialysis. Only 2 patients required intraoperative RRT. There was no difference in the incidence of acidosis or hyperkalemia between patients who required preoperative dialysis and those who did not. Conclusions: We describe the successful management of patients undergoing liver or SLK transplantation almost entirely without the need for intraoperative RRT. Abstract : The UCSF group reports excellent outcomes without the use of intraoperative RRT in liver transplantation. Implications for anesthetic strategy are discussed.