Renal support during liver transplantation: when to consider it?

Area of Science:

• Nephrology
• Transplantation Surgery
• Critical Care Medicine

Background:

• Liver transplant recipients frequently present with multiorgan dysfunction, including acute kidney injury and fluid-electrolyte disturbances.
• Complex surgical procedures and massive fluid resuscitation can worsen patient conditions, leading to severe metabolic derangements.
• These factors highlight the challenges in managing liver transplant patients, particularly those with pre-existing kidney issues.

Purpose of the Study:

• To discuss the indications and strategies for intraoperative renal replacement therapy (ioRRT) in orthotopic liver transplantation.
• To examine the benefits and drawbacks of implementing ioRRT in this complex patient population.
• To review current clinical experiences with ioRRT during liver transplantation.

Main Methods:

• Review of common indications for ioRRT in liver transplant recipients.
• Analysis of various ioRRT strategies and their associated advantages and disadvantages.
• Synthesis of current clinical experiences and outcomes related to ioRRT.

Main Results:

• ioRRT is indicated for critically ill liver transplant patients, especially those with kidney dysfunction or anticipated surgical difficulties.
• Different ioRRT modalities offer varying benefits and risks that must be carefully considered.
• Implementation of ioRRT can help manage fluid overload, electrolyte imbalances, and acid-base disturbances during surgery.

Conclusions:

• Intraoperative renal replacement therapy (ioRRT) is a valuable intervention for select liver transplant patients.
• Careful patient selection and appropriate strategy selection are key to successful ioRRT.
• ioRRT can mitigate perioperative complications and improve outcomes in complex liver transplant cases.