Inefficacy of Intraoperative Renal Replacement Therapy in Mitigating Early Allograft Dysfunction Among Liver...

Intraoperative continuous renal replacement therapy (IoCRRT) represents a viable approach for managing the hemodynamic and metabolic challenges encountered during liver transplantation (LT), particularly in high-acuity patients. Our objective was to evaluate the impact of IoCRRT in comparison with conservative treatment on liver graft function during the immediate post-transplant period.

This retrospective, bicentric cohort study included patients who underwent LT between January 2014 and December 2019. Propensity score matching was conducted to mitigate disparities between the IoCRRT and control groups. Comparative analysis of post-transplant outcomes encompassed early allograft dysfunction (EAD), as defined by Olthoff, along with quantitative evaluation using the Model for Early Allograft Function (MEAF) scoring.

The analysis included 73 patients in both groups, demonstrating comparability, with a mean MELD score of 31.5 ± 9.4 in the IoCRRT group compared to 30.6 ± 9.6 (SMD, Standardized mean difference = 0.088) in the control group. The overall frequency of EAD was 32.9% in the IoCRRT group and 43.8% in the control group (P = .243), with quantitative assessment using the MEAF score yielding 6.81 versus 6.89 (P = .843), respectively. No significant differences were observed in the length of stay in the intensive care unit or 90-day mortality.

Implementation of IoCRRT during LT did not correlate with a reduction in the occurrence or severity of early allograft dysfunction.