Korean J Crit Care Med.  2013 Nov;28(4):309-313. 10.4266/kjccm.2013.28.4.309.

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation

• Kim JH
• Lim BR
• Jung JY

• KMID: 1977508
• DOI: http://doi.org/10.4266/kjccm.2013.28.4.309

Abstract

A review of the literature regarding combined liver-kidney transplantation (CLKT) does not provide adequate central venous pressure (CVP) values that would allow for unimpaired hepatic venous outflow and early renal allograft diuresis during the procedure. We report a case of fluid management of CLKT based on the limited literature available in a 59-year-old male with liver cirrhosis and end-stage renal disease. During the preanhepatic phase, CVP was maintained at 5 mmHg. Following portal vein clamping, CVP was reduced to below 5 mmHg until venovenous bypass was initiated. From the neohepatic phase to 1 hour before renal allograft reperfusion, CVP was slowly increased to 10 mmHg. Within an hour before renal allograft reperfusion, maximal crystalloid hydration was used to increase CVP to 15 mmHg. The urine output was replaced to maintain CVP at 8 to 10 mmHg until the end of the surgery. The postoperative course was uneventful. In conclusion, fluid management tailored to each phase yielded beneficial results in a patient with CLKT.

Keyword

central venous pressure; kidney transplantation; liver transplantation

MeSH Terms

Central Venous Pressure
Constriction
Diuresis
Humans
Isotonic Solutions
Kidney Failure, Chronic
Kidney Transplantation
Liver Cirrhosis
Liver Transplantation
Male
Middle Aged
Portal Vein
Reperfusion
Transplantation, Homologous
Isotonic Solutions