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Updated: Jun 26, 2026
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Heterotopic Auxiliary Whole Liver Rat Transplant Model Utilizing a Hepaticoureterostomy for Allograft Rejection Studies
Published on: March 8, 2024
Intraoperative renal support during liver transplantation
Derek R Townsend1, Sean M Bagshaw, Michael J Jacka
1Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada.
Summary
Intraoperative continuous renal replacement therapy (CRRT) during liver transplantation is safe and feasible for patients with acute kidney injury (AKI). This approach supports fluid balance and shows promising survival and renal recovery rates post-transplant.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Surgery
Background:
- Acute kidney injury (AKI) is a frequent complication in patients with liver failure awaiting orthotopic liver transplantation (OLT).
- AKI can significantly complicate the intraoperative period during OLT, posing challenges for patient management.
Purpose of the Study:
- To describe the logistics and clinical outcomes of intraoperative continuous renal replacement therapy (CRRT) during OLT.
- To evaluate the safety and efficacy of CRRT in OLT patients with preoperative AKI.
Main Methods:
- Retrospective review of adult patients undergoing OLT with intraoperative CRRT between 1996-2005.
- Data collected included demographics, clinical status, perioperative measures, CRRT details, and renal recovery/survival outcomes.
Main Results:
- 41 out of 636 OLTs (6.4%) received intraoperative CRRT, primarily for hepatitis C or alcoholic cirrhosis.
- CRRT averaged 57% of operative time, with 40% experiencing filter clotting but no significant impact on duration.
- 92.7% achieved neutral or negative fluid balance; 78% continued CRRT post-OLT, with 100% renal recovery in survivors by 1 year, though many had reduced eGFR.
Conclusions:
- Intraoperative CRRT during OLT is achievable and safe.
- CRRT may serve as a valuable adjunct therapy for OLT patients with preoperative AKI.
- Further research is warranted to fully elucidate the role and long-term impact of intraoperative CRRT in OLT.
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