Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Outcome analysis of continuous intraoperative renal replacement therapy in the highest acuity liver transplant recipients: A single-center experience. Surgery 2017 05;161(5):1279-1286

Date

12/25/2016

Pubmed ID

28011008

DOI

10.1016/j.surg.2016.10.027

Scopus ID

2-s2.0-85008237865   6 Citations

Abstract

BACKGROUND: Orthotopic liver transplantation is the definitive treatment modality for patients with end-stage liver disease. Pre-orthotopic liver transplantation renal dysfunction has a significant negative influence on outcomes post-orthotopic liver transplantation. Intraoperative renal replacement therapy is an adjunctive therapy to address the metabolic challenges during orthotopic liver transplantation in patients with a high acuity of illness. The impact of intraoperative renal replacement therapy on post-orthotopic liver transplantation outcomes, however, is unclear.

METHODS: From October of 2012 to April of 2016, 96 adult patients underwent orthotopic liver transplantation for end-stage liver disease. Three groups were identified: (1) Group I: patients with pre-orthotopic liver transplantation renal dysfunction who underwent intraoperative renal replacement therapy, (2) Group II: patients with pre-orthotopic liver transplantation renal dysfunction who did not receive intraoperative renal replacement therapy, and (3) Group III: patients with orthotopic liver transplantation without evidence of pretransplant renal dysfunction.

RESULTS: At 17.7 months follow-up, there was no difference in survival among the study groups. Physiologic model for end-stage liver disease at the time of orthotopic liver transplantation was significantly higher in both groups with renal dysfunction (I = 43, II = 39) than in Group III (18). Post-orthotopic liver transplantation, 12-month patient survival in Group II was 100%. While the model for end-stage liver disease score at orthotopic liver transplantation was significantly different between Group I and Group III, the 12-month, post-orthotopic liver transplantation patient survival was comparable at 78% vs 88%, respectively.

CONCLUSION: Intraoperative renal replacement therapy is a safe adjunctive therapy during liver transplantation of critically ill patients with renal dysfunction. Identifying patients who require intraoperative renal replacement therapy would improve intraoperative and post-liver transplant survival and may facilitate recovery of native kidney function after transplant.

Author List

Zimmerman MA, Selim M, Kim J, Regner K, Saeian K, Zanowski S, Martin A, Connolly LA, Lauer KK, Woehlck HJ, Hong JC

Authors

Lois A. Connolly MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Joohyun Kim MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Kathryn K. Lauer MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Kevin R. Regner MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
Motaz Selim MBBS, MSc, MD, PhD Assistant Professor in the Surgery department at Medical College of Wisconsin
Stephanie Chadsey Zanowski PhD Assistant Professor in the Surgery department at Medical College of Wisconsin
Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cohort Studies
End Stage Liver Disease
Female
Humans
Intraoperative Care
Liver Transplantation
Male
Middle Aged
Renal Insufficiency
Renal Replacement Therapy
Treatment Outcome
jenkins-FCD Prod-411 e00897e83867fcfa48419861683711f8d99adb75