Ann Surg Treat Res.  2018 Jul;95(1):45-53. 10.4174/astr.2018.95.1.45.

Intraoperative management of liver transplant recipients having severe renal dysfunction: results of 42 cases

• Kim HY
• Lee JE
• Ko JS
• Gwak MS
• Lee SK
• Kim GS

• KMID: 2414452
• DOI: http://doi.org/10.4174/astr.2018.95.1.45

Abstract

PURPOSE
Whereas continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT), there was a lack of evidence to support this practice. We investigated the adverse events at the perioperative periods in recipients of LT who received preoperative CRRT without intraoperative CRRT.
METHODS
We retrospectively reviewed medical records of adult patients (age ≥ 18 years) who received LT between December 2009 and May 2015. Perioperative data were collected from the recipients, who received preoperative CRRT until immediately before LT, because of refractory renal dysfunction.
RESULTS
Of 706 recipients, 42 recipients received preoperative CRRT. The mean (standard deviation) Model for end-stage liver disease score were 49.6 (13.4). Twenty-six point two percent (26.2%) of recipients experienced the serum potassium > 4.5 mEq/L before reperfusion and treated with regular insulin. Thirty-eight point one percent (38.1%) of recipients were managed with sodium bicarbonate because of acidosis (base excess <−10 mEq/L throughout LT). All patients finished their operations without medically uncontrolled complications such as severe hyperkalemia (serum potassium > 5.5 mEq/L), refractory acidosis, or critical arrhythmias. Mortality was 19% at 30 day and 33.3% at 1 year.
CONCLUSION
Although intraoperative CRRT was not used in recipients with severe preoperative renal dysfunction, LT was safely performed. Our experience raises a question about the need for intraoperative CRRT.

Keyword

Liver transplantation; Complications; Renal replacement therapy

MeSH Terms

Acidosis
Adult
Arrhythmias, Cardiac
Humans
Hyperkalemia
Insulin
Liver Diseases
Liver Transplantation
Liver*
Medical Records
Mortality
Perioperative Period
Potassium
Renal Replacement Therapy
Reperfusion
Retrospective Studies
Sodium Bicarbonate
Transplant Recipients*
Insulin
Potassium
Sodium Bicarbonate

Figure

• 

  Fig. 1 The changes of values over time. Vertical axis, mean values of each parameter. Horizontal axis, each time point; 0, postinduction; 1, 1 hour after postinduction time; 2, 2 hours after postinduction time; 3, initiation of anhepatic phase; 4, 1 hour after anhepatic phase; 5, 5 minutes after reperfusion; 6, 30 minutes after reperfusion; 7, 1 hour after reperfusion; 8, 2 hours after reperfusion; 9, arrival at the intensive care unit. PaCO2, arterial carbon dioxide partial pressure; PaO2, arterial oxygen partial pressure; HCO3 , bicarbonate ion.

• 

  Fig. 2 KaplanMeier patient survival estimates after liver transplantation.

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