Ann Surg Treat Res.  2018 Jul;95(1):45-53. 10.4174/astr.2018.95.1.45.

Intraoperative management of liver transplant recipients having severe renal dysfunction: results of 42 cases

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 2Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. gskim@skku.edu
  • 3Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

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.

Keyword

Liver transplantation; Complications; Renal replacement therapy

MeSH Terms

Acidosis
Adult
Arrhythmias, Cardiac
Humans
Hyperkalemia
Insulin
Liver Diseases
Liver Transplantation
Liver*
Medical Records
Mortality
Perioperative Period
Potassium
Renal Replacement Therapy
Reperfusion
Retrospective Studies
Sodium Bicarbonate
Transplant Recipients*
Insulin
Potassium
Sodium Bicarbonate

Figure

  • Fig. 1 The changes of values over time. Vertical axis, mean values of each parameter. Horizontal axis, each time point; 0, postinduction; 1, 1 hour after postinduction time; 2, 2 hours after postinduction time; 3, initiation of anhepatic phase; 4, 1 hour after anhepatic phase; 5, 5 minutes after reperfusion; 6, 30 minutes after reperfusion; 7, 1 hour after reperfusion; 8, 2 hours after reperfusion; 9, arrival at the intensive care unit. PaCO2, arterial carbon dioxide partial pressure; PaO2, arterial oxygen partial pressure; HCO3 , bicarbonate ion.

  • Fig. 2 KaplanMeier patient survival estimates after liver transplantation.


Reference

1. Lau C, Mar t, Bunnapradist S. Management of renal dysfunction in patients receiving a liver transplant. Clin Liver Dis. 2011; 15:807–820. PMID: 22032530.
Article
2. Matuszkiewicz-Rowińska J, Wieliczko M, Małyszko J. Renal replacement therapy before, during, and after orthotopic liver transplantation. Ann Transplant. 2013; 18:248–255. PMID: 23792528.
Article
3. Ikegami T, Shirabe K, Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, et al. The impact of renal replacement therapy before or after living donor liver transplantation. Clin Transplant. 2012; 26:143–148. PMID: 21447144.
Article
4. Nadim MK, Annanthapanyasut W, Matsuoka L, Appachu K, Boyajian M, Ji L, et al. Intraoperative hemodialysis during liver transplantation: a decade of experience. Liver Transpl. 2014; 20:756–764. PMID: 24634344.
Article
5. Parmar A, Bigam D, Meeberg G, Cave D, Townsend DR, Gibney RT, et al. An evaluation of intraoperative renal support during liver transplantation: a matched cohort study. Blood Purif. 2011; 32:238–248. PMID: 21829016.
Article
6. Townsend DR, Bagshaw SM, Jacka MJ, Bigam D, Cave D, Gibney RT. Intraoperative renal support during liver transplantation. Liver Transpl. 2009; 15:73–78. PMID: 19109832.
Article
7. Akhoundi A, Singh B, Vela M, Chaudhary S, Monaghan M, Wilson GA, et al. Incidence of adverse events during continuous renal replacement therapy. Blood Purif. 2015; 39:333–339. PMID: 26022612.
Article
8. Dawwas MF, Lewsey JD, Watson CJ, Gimson AE. UK, Ireland Liver Transplant Audit. The impact of serum potassium concentration on mortality after liver transplantation: a cohort multicenter study. Transplantation. 2009; 88:402–410. PMID: 19667945.
Article
9. Shangraw RE. Metabolic issues in liver transplantation. Int Anesthesiol Clin. 2006; 44:1–20.
Article
10. Kamath PS, Kim WR. Advanced Liver Disease Study Group. The model for endstage liver disease (MELD). Hepatology. 2007; 45:797–805. PMID: 17326206.
Article
11. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964; 1:1–85. PMID: 4950264.
12. Bang SR, Ahn HJ, Kim GS, Yang M, Gwak MS, Ko JS, et al. Predictors of high intraoperative blood loss derived by simple and objective method in adult living donor liver transplantation. Transplant Proc. 2010; 42:4148–4150. PMID: 21168648.
Article
13. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010; 362:779–789. PMID: 20200382.
Article
14. De Backer D, Creteur J, Silva E, Vincent JL. Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med. 2003; 31:1659–1667. PMID: 12794401.
Article
15. Russell JA, Walley KR, Singer J, Gordon AC, Hébert PC, Cooper DJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008; 358:877–887. PMID: 18305265.
Article
16. Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am J Transplant. 2006; 6:2651–2659. PMID: 16939515.
Article
17. Gonwa TA, Mai ML, Melton LB, Hays SR, Goldstein RM, Levy MF, et al. Renal replacement therapy and orthotopic l iver transplant ation: the role of continuous veno-venous hemodialysis. Transplantation. 2001; 71:1424–1428. PMID: 11391230.
18. Salord F, Bailly MP, Gaussorgues P, Workineh S, Pouyet M, Robert D. Continuous arteriovenous haemodialysis during emergency hepatic retransplantation: two case reports. Intensive Care Med. 1990; 16:330–331. PMID: 2212260.
Article
19. Douthitt L, Bezinover D, Uemura T, Kadry Z, Shah RA, Ghahramani N, et al. Perioperative use of continuous renal replacement therapy for orthotopic liver transplantation. Transplant Proc. 2012; 44:1314–1317. PMID: 22664007.
Article
20. Vitin A, Muczynski K, Bakthavatsalam R, Martay K, Dembo G, Metzner J. Treatment of severe lactic acidosis during the preanhepatic stage of liver transplant surgery with intraoperative hemodialysis. J Clin Anesth. 2010; 22:466–472. PMID: 20868970.
Article
21. Sedra AH, Strum E. The role of intraoperative hemodialysis in liver transplant patients. Curr Opin Organ Transplant. 2011; 16:323–325. PMID: 21543980.
Article
22. Bellomo R, Harris C, Kang Y, Daniel E, Fung JJ, Bronsther O. Combined veno-venous bypass and high volume hemofiltration during orthotopic liver transplantation. ASAIO J. 1993; 39:954–956. PMID: 8123934.
Article
23. Agopian VG, Dhillon A, Baber J, Kaldas FM, Zarrinpar A, Farmer DG, et al. Liver transplantation in recipients receiving renal replacement therapy: outcomes analysis and the role of intraoperative hemodialysis. Am J Transplant. 2014; 14:1638–1647. PMID: 24854341.
Article
24. Gruber M, Breu A, Frauendorf M, Seyfried T, Hansen E. Washing of banked blood by three different blood salvage devices. Transfusion. 2013; 53:1001–1009. PMID: 22897672.
Article
25. Vraets A, Lin Y, Callum JL. Transfusion-associated hyperkalemia. Transfus Med Rev. 2011; 25:184–196. PMID: 21498041.
Article
26. Glanemann M, Langrehr J, Kaisers U, Schenk R, Müller A, Stange B, et al. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand. 2001; 45:333–339. PMID: 11207470.
Article
27. Snowden CP, Hughes T, Rose J, Roberts DR. Pulmonary edema in patients after liver transplantation. Liver Transpl. 2000; 6:466–470. PMID: 10915170.
Article
28. Lin YH, Cai ZS, Jiang Y, Lü LZ, Zhang XJ, Cai QC. Perioperative risk factors for pulmonary complications after liver transplantation. J Int Med Res. 2010; 38:1845–1855. PMID: 21309501.
Article
29. Feltracco P, Carollo C, Barbieri S, Pettenuzzo T, Ori C. Early respiratory complications after liver transplantation. World J Gastroenterol. 2013; 19:9271–9281. PMID: 24409054.
Article
30. Wi W, Hahm TS, Kim GS. A case series on simultaneous l iver and kidney transplantation: do we need intraoperative renal replacement therapy? Korean J Anesthesiol. 2017; 70:467–476. PMID: 28794844.
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr