[Artificial renal supports in surgery--present status and problems]

Clinical and surgical situation and problems of the blood purification as an artificial renal supports, including hemodialysis, hemofiltration and hemoadsorption, were studied especially fields related with treatment of acute renal failure (ARF), surgeries in the patients treated with chronic hemodialysis and supportive care for the cadaveric renal transplantation. ARF: Our experimental data using septic rats showed that hemoadsorption activated host's reticuloendothelial function and consequently increased survival rate of septic rats. Clinically, similar results were observed by the combination of hemodialysis and hemoadsorption, and the survival rate of ARF with multiple organ failure increased to 68% (21 out of 31 cases) from 30% (8 out of 27) in the patients treated with only hemodialysis. Surgery in the chronic hemodialysis patients: One hundred twenty two operations have been done among the patients treated with chronic hemodialysis in our clinic. However, 15 in emergency cases were died within post operative period. There is no operative death in scheduled operations including total esophagectomy and simultanous radical operation of gall bladder cancer and colon cancer. Pre- and post operative supportive management with immunopotentiator, opsonic protein, coagulative factors and intravenous hyperalimentation with branched chain rich amino acid solution should be added routinely to artificial renal supports in pre- and post operative period. Cadaveric renal transplantation: Eighty-seven percent of cadaveric renal transplantation in our clinic were needed artificial renal support in early phase of post transplantation period because of insufficient renal function by acute tubular necrosis. Necessity of the acceptance of brain death category in Japan is strongly pleaded.