Intraoperative management of liver transplant patients without the routine use of renal replacement therapy

AbstractBackgroundRenal failure is common among patients undergoing liver transplantation. Liver allocation based on the MELD score has increased the number of recipients who require perioperative RRT. Although renal replacement therapy (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.MethodsWe performed a retrospective analysis of all adult patients undergoing orthotopic liver- or simultaneous liver and kidney transplantation between June, 2009 and December, 2015. Patients were divided into 2 groups based on their need for pretransplant RRT.Results785 patients underwent liver- or simultaneous liver-kidney transplant during the study period. 174 (22.2%) patients 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 that did not.ConclusionsWe describe the successful management of patients undergoing liver- or simultaneous liver and kidney transplantation almost entirely without the need for intraoperative RRT. Background Renal failure is common among patients undergoing liver transplantation. Liver allocation based on the MELD score has increased the number of recipients who require perioperative RRT. Although renal replacement therapy (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. Methods We performed a retrospective analysis of all adult patients undergoing orthotopic liver- or simultaneous liver and kidney transplantation between June, 2009 and December, 2015. Patients were divided into 2 groups based on their need for pretransplant RRT. Results 785 patients underwent liver- or simultaneous liver-kidney transplant during the study period. 174 (22.2%) patients 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 that did not. Conclusions We describe the successful management of patients undergoing liver- or simultaneous liver and kidney transplantation almost entirely without the need for intraoperative RRT. Correspondence information: Dieter Adelmann, MD, Department of Anesthesia & Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA. dieter.adelmann@ucsf.edu Authorship: D.A., J.R.F. and C.U.N. drafted the study protocol. C.U.N. obtained Institutional Review Board approval D.A. and J.R.F. collected patients' data D.A. an J.R.F. performed the statistical analysis. D.A., A.O., L.L.L., G.R.R., L.B., M.T. S.S. and B.O. and C.U.N. prepared the manuscript. Disclosures: The authors declare no conflicts of interest Funding: This study was supported by departmental funds. (Department of Anesthesia and Perioperative Care San Francisco, University of California, San Francisco, CA) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2EMVxK4