Korean J Anesthesiol.  2017 Aug;70(4):467-476. 10.4097/kjae.2017.70.4.467.

A case series on simultaneous liver and kidney transplantation: do we need intraoperative renal replacement therapy?

• Wi W
• Hahm TS
• Kim GS

• KMID: 2386302
• DOI: http://doi.org/10.4097/kjae.2017.70.4.467

Abstract

Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Recipients of SLKT tend to have a lower pre-transplant kidney function and the longer operation time mandates a larger amount of fluid than LT alone. Hence, anesthetic care is more prone to be challenged by hyperkalemia, metabolic acidosis, and volume overload, making ioRRT a theoretically valuable intervention. However, in all five cases, recipients were managed without ioRRT, resulting in excellent graft and patient survival. As such, in this case series, we discuss current issues about ioRRT and SLKT.

Keyword

Acidosis; Hyperkalemia; Liver transplantation; Renal replacement therapy

MeSH Terms

Acidosis
Humans
Hyperkalemia
Kidney Transplantation*
Kidney*
Liver Diseases
Liver Transplantation
Liver*
Renal Replacement Therapy*
Transplants