Intraoperative Renal Replacement Therapy During Liver and Liver-Kidney Transplant: Outcomes of 155 Cases
1Transplantation, Mayo Clinic, Jacksonville, FL
2Florida State University, Tallahassee, FL.
Meeting: 2015 American Transplant Congress
Abstract number: B140
Keywords: Kidney/liver transplantation, Liver transplantation, Renal dysfunction
Session Information
Session Name: Poster Session B: Liver - Kidney Issues in Liver Transplantation
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background: Renal dysfunction in liver (LT) and liver-kidney (LKT) transplant candidates increases intraoperative risks of electrolyte disturbances and volume excess complications. The role of intraoperative renal replacement therapy (ioRRT) to improve outcomes is uncertain. We retrospectively reviewed LT and LKT recipients to compare renal function and survival in those receiving ioRRT and those without.
Methods: Data was retrospectively collected on 1582 consecutive LT and LKT recipients from Jan 2003 to Dec 2011. 155 received ioRRT. ioRRT was considered in those: needing preop RRT, preop Cr > 1.5 mg/dl, preop K+ > 5 meq/L. Continuous veno-veno hemodialysis/diafiltration was used. K+ bath varied until 2005 when 0K+ bath became the norm. Default blood flow rate was 200 ml/min, default replacement fluid or dialysate was 2400 ml/hr and default net ultrafiltration was 100 ml/hr adjusted by anesthesiologist. Renal function using serum creatinine (Cr) and measured glomerular filtration rate (GFR) by iothalamate was obtained at 1, 4 and 12 months. One year patient survival was observed.
Results: Of the 1582 patients, 1521 underwent LT and 61 LKT. 116 of the LT and 39 of the LKT had ioRRT. Of the 155 patients receiving ioRRT, 75 (48%) had preop RRT and 83 (54%) had postop RRT. Only 101 of the 1427 (7%) patients without ioRRT needed postop RRT. Renal function is summarized in Table 1. Assessment of renal function by Cr was statistically worse at all periods (p<0.001), but one year measured GFR was not statistically different. One year patient survival for those with ioRRT was 91% compared to 91.9% for those without (p=0.7). At 1 year, survival in those with ioRRT undergoing postop RRT was 88.9% versus 94.4% in those without (p=0.05). In patients without ioRRT, 1 year survival with postop RRT was 72% versus 93.5% without (p<0.001). In any patient with postop RRT, 1 year survival was 79% compared to 93.5% in those without (p=0.001).
| ioRRT | Cr mg/dl ±SEM | |
| 1 month | Yes | 1.54 ±0.89 |
| No | 1.17 ±0.48 | |
| 4 month | Yes | 1.60 ±0.82 |
| No | 1.30 ±0.68 | |
| 12 month | Yes | 1.71 ±1.18 |
| No | 1.25 ±0.60 | |
| Clearance ml/min | ||
| Iothalamate | Yes | 51.36 ±18.60 |
| No | 52.62 ±24.68 |
Conclusions: Although Cr was statistically higher in those patients with ioRRT, the one year GFR was similar. One year post transplant survival in those receiving ioRRT was not statistically different than those without. Postop RRT adversely affects survival.
To cite this abstract in AMA style:
Mai M, Golan E, Croome K, Keaveny A, Taner B, Gonwa T, Wadei H. Intraoperative Renal Replacement Therapy During Liver and Liver-Kidney Transplant: Outcomes of 155 Cases [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/intraoperative-renal-replacement-therapy-during-liver-and-liver-kidney-transplant-outcomes-of-155-cases/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress