[Causes of renal dysfunction during the anhepatic phase in patients for orthotopic liver transplantation and their...

This study was carried out to clarify causes of renal dysfunction during the anhepatic phase in orthotopic liver transplantation (OLT) with venovenous bypass and to show how the deterioration impacted on postoperative renal function. The 44 consecutive patients with normal preoperative renal function who underwent OLT in Royal Prince Alfred Hospital were classified into two groups according to creatinine clearance (Ccr) during the anhepatic phase. Group 1 consisted of 27 patients whose Ccr levels levels were kept above 60 ml.min-1.m-2 and group 2 consisted of 17 patients under 60 ml.min-1.m-2. In group 2, preoperative International Normalized Ratio for prothrombin was higher and blood transfusion volume before revascularization was significantly lager than group 1. There were significant differences in haemodynamics just before revascularization (mean arterial pressure 95 +/- 14 vs 83 +/- 14 mmHg, pulmonary artery wedge pressure 16 +/- 5 vs 11 +/- 5 mmHg, cardiac index 4.6 +/- 1.3 vs 4.0 +/- 0.9 l.min-1.m-2, group 1 vs group 2, mean +/- SD, P < 0.05). Serum creatinine levels in group 2 were significantly higher postoperatively. It is suggested that bleeding due to insufficient preoperative coagulability caused haemodynamic instability which deteriorated renal function during the anhepatic phase and the deterioration impacted on postoperative renal function.