Effects of Intraoperative Continuous Renal Replacement Therapy on Outcomes in Liver Transplantation.
Safwan M, Gosnell J, Collins K, Rizzari M, Yoshida A, Abouljoud M, and Nagai S. Effects of Intraoperative Continuous Renal Replacement Therapy on Outcomes in Liver Transplantation. Transplant Proc 2019.
BACKGROUND: Intraoperative continuous renal replacement therapy (CRRT) may need to be indicated for liver transplant recipients who show renal dysfunction. We aimed to investigate effects of intraoperative CRRT on outcomes after liver transplant.
MATERIAL AND METHODS: This study included all adult patients who underwent liver transplant between January 2005 and May 2017 and were found to have renal dysfunction, which was defined as glomerular filtration rate < 30 mL/min at transplant. The patients were divided into 3 groups for outcome analysis: elective CRRT group (renal replacement therapy was already introduced pretransplant, group 1, n = 70), urgent CRRT (intraoperative CRRT was indicated because of unexpected renal dysfunction, group 2, n = 15), and no CRRT group (no intraoperative CRRT even with renal dysfunction, group 3, n = 57). Post-transplant outcomes were analyzed to determine effects of CRRT.
RESULTS: Postoperative complication rates were similar in the 3 groups (P = .056). Group 1 showed the highest rate of postoperative renal replacement therapy (86.4% in group 1 vs 66.7% and 10.7% in groups 2 and 3, P < .001). Long-term renal function (at 3, 6, and 12 months post transplant) was similar among the 3 groups (P = .50, .77, and .52, respectively). Group 1 showed a higher risk of 1-year graft loss (hazard ratio, 2.55; P = .03) and mortality (hazard ratio, 2.71; P = .03) than group 3, whereas groups 2 and 3 were similar.
CONCLUSION: CRRT used in the urgent setting did not show obvious benefit. Hence, its application should be carefully considered in those who unexpectedly present with acute kidney injury at the time of transplant.
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