Intraoperative Dialysis During Liver Transplantation

Area of Science:

• Nephrology
• Hepatology
• Transplant Surgery

Background:

• Orthotopic liver transplantation (LT) is complex, risking hemodynamic instability and metabolic issues, especially with renal dysfunction.
• Intraoperative renal replacement therapy (ioRRT) is used to support patients with preoperative renal failure during LT.
• Limited data exists on the benefits of ioRRT in LT patients.

Purpose of the Study:

• To evaluate the safety and effectiveness of intraoperative dialysis (ioRRT) in patients undergoing orthotopic liver transplantation.
• To assess complications and outcomes associated with ioRRT in this high-risk population.

Main Methods:

• Retrospective observational study of adult patients undergoing intraoperative dialysis from 2010-2016.
• Included patients with preoperative renal failure and high MELD scores undergoing LT.
• Data collected on patient characteristics, perioperative parameters, and complications.

Main Results:

• 88 patients with a mean MELD score of 31.4 underwent ioRRT during LT.
• 50% of recipients were ICU-admitted pre-transplant; 21.6% required mechanical ventilation.
• Postreperfusion syndrome occurred in 13.9% of patients; dialysis circuit clotting in 9.1%; no other adverse ioRRT events reported.

Conclusions:

• Intraoperative dialysis is safe and effective for severely ill LT patients with high MELD scores.
• The observed low rate of postreperfusion syndrome warrants further investigation in a controlled study.
• ioRRT can be a valuable supportive therapy in complex liver transplant cases.