Related Experiment Video
Updated: May 5, 2026
Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Intraoperative renal replacement therapy during liver transplantation in children: Safety, efficacy and impact on
Kristin J Dolan1, Ayse Arikan1,2, Anna M Banc-Husu3
1Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA.
Insights
Intraoperative Continuous Renal Replacement Therapy (iCRRT) is safe for pediatric liver transplants, aiding fluid and metabolic balance. Careful patient selection is crucial for this intensive therapy in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Transplantation Surgery
Background:
- Intraoperative Continuous Renal Replacement Therapy (iCRRT) benefits adults undergoing liver transplantation (LT).
- Limited data exists on iCRRT's use in pediatric LT.
- This study evaluates iCRRT safety, efficacy, and survival impact in pediatric LT.
Purpose of the Study:
- To assess the safety and efficacy of iCRRT in pediatric liver transplantation.
- To determine the impact of iCRRT on survival rates in pediatric LT recipients.
- To compare outcomes between pediatric LT patients who received iCRRT and those who did not.
Main Methods:
- Retrospective cohort study (2014-2022) of children requiring CRRT pre-LT.
- Comparison of demographic characteristics, intraoperative events, and post-LT outcomes.
- Analysis of patients receiving iCRRT versus those not receiving iCRRT.
Main Results:
- 11 out of 306 (3.6%) pediatric LT patients received iCRRT.
- iCRRT patients had increased blood loss and transfusion needs but similar intraoperative metabolic balance.
- One-year post-LT mortality rates were comparable between groups.
Conclusions:
- iCRRT is a safe option for critically ill children with pre-LT renal dysfunction undergoing LT.
- iCRRT aids fluid resuscitation and metabolic homeostasis but requires careful patient selection.
- This intensive therapy can benefit fragile pediatric LT populations when appropriately indicated.
Background:
Intraoperative Continuous Renal Replacement Therapy (iCRRT) can prevent life-threatening complications, facilitate fluid management, and maintain metabolic homeostasis during liver transplantation (LT) in adults. There is a paucity of data in pediatric LT. We evaluated the safety, efficacy, and impact on survival of iCRRT in pediatric LT.
Methods:
We conducted a retrospective cohort study of all children requiring CRRT pre-OLT at a quaternary children's hospital from 2014 to 2022. Demographic characteristics, intraoperative events, and post-LT outcomes were compared between those who received iCRRT and those who did not.
Results:
Out of 306 patients who received LT, 30 (10%) were supported with CRRT at least 24 h prior to LT, of which 11 (36%) received iCRRT. The two cohorts were similar in demographics, diagnosis of liver disease, and severity of illness. The iCRRT patients experienced massive blood loss and increased transfusion requirements. There was no difference in intraoperative metabolic balance. One-year post-LT mortality rates were similar.
Conclusion:
ICRRT is safe in critically ill children with pre-LT renal dysfunction. It optimizes fluid and blood product resuscitation while maintaining metabolic homeostasis. Candidates need to be carefully chosen for this highly resource-intensive therapy to benefit this fragile population.
Related Concept Videos
01:26Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
01:30Continuous Renal Replacement Therapy
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management