Intraoperative kidney replacement therapy in acute liver failure

Area of Science:

• Pediatric Critical Care Medicine
• Nephrology
• Hepatology

Background:

• Paediatric acute liver failure (PALF) is a severe condition with high morbidity and mortality.
• Acute kidney injury (AKI) is a frequent complication of PALF, impacting patient outcomes.
• Continuous kidney replacement therapy (CKRT) is often required for severe AKI in PALF and liver transplant patients.

Purpose of the Study:

• To provide a comprehensive guide on intraoperative CKRT (IoCKRT) for paediatric liver transplantation.
• To discuss the rationale, practicalities, and evidence for IoCKRT in this vulnerable population.

Main Methods:

• Review of existing literature and clinical experience regarding IoCKRT in paediatric liver transplantation.
• Analysis of the perioperative benefits of CKRT, including toxin clearance, electrolyte balance, fluid management, and intracranial pressure control.

Main Results:

• IoCKRT is demonstrated to be practicable and safe during paediatric liver transplantation.
• IoCKRT may enable sicker recipients to tolerate surgery, potentially improving outcomes.

Conclusions:

• IoCKRT offers potential perioperative benefits, extending CKRT's advantages into the intraoperative period.
• Further evidence supports the consideration of IoCKRT to manage critically ill children undergoing liver transplantation.