Outcome analysis of continuous intraoperative renal replacement therapy in the highest acuity liver transplant recipients: A single-center experience. Surgery 2017 May;161(5):1279-1286
Date
12/25/2016Pubmed ID
28011008DOI
10.1016/j.surg.2016.10.027Scopus ID
2-s2.0-85008237865 (requires institutional sign-in at Scopus site) 22 CitationsAbstract
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 JCAuthors
Lois A. Connolly MD Professor in the Anesthesiology department at Medical College of WisconsinJoohyun 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 Interim Chair, Professor in the Medicine department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
Harvey J. Woehlck MD Professor in the Anesthesiology department at Medical College of Wisconsin
Stephanie Chadsey Zanowski PhD Director, Associate Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Cohort Studies
End Stage Liver Disease
Female
Humans
Intraoperative Care
Liver Transplantation
Male
Middle Aged
Renal Insufficiency
Renal Replacement Therapy
Treatment Outcome
