Intraoperative management of liver transplant recipients having severe renal dysfunction: results of 42 cases.
10.4174/astr.2018.95.1.45
- Author:
Ha Yeon KIM
1
;
Ja Eun LEE
;
Justin S KO
;
Mi Sook GWAK
;
Suk Koo LEE
;
Gaab Soo KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
- Publication Type:Original Article
- Keywords:
Liver transplantation;
Complications;
Renal replacement therapy
- MeSH:
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*
- From:Annals of Surgical Treatment and Research
2018;95(1):45-53
- CountryRepublic of Korea
- Language:English
-
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.
