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KMID : 0371420180950010045
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Annals of Surgical Treatment and Research
2018 Volume.95 No. 1 p.45 ~ p.53
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Intraoperative management of liver transplant recipients having severe renal dysfunction: results of 42 cases
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Kim Ha-Yeon
Lee Ja-Eun
Ko Justin S.
Gwak Mi-Sook
Lee Suk-Koo
Kim Gaab-Soo
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Abstract
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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.
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KEYWORD
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Liver transplantation, Complications, Renal replacement therapy
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