Renal dysfunction in liver transplant (LT) candidates increases intraoperative risks. One year survival in patients requiring pre or post operative renal replacement therapy (RRT) is 40-78%. Intraoperative continuous renal replacement therapy (ioRRT) may improve safety and outcome. We retrospectively reviewed LT or liver-kidney transplant (LKT) recipients to compare survival and renal outcomes of those with ioRRT to those without.

Methods:Data was retrospectively collected on 667 consecutive LT and LKT recipients from Jan 2006 to Dec 2009. 105 received ioRRT. ioRRT was chosen based on the following guidelines: need for preop RRT, preop Cr > 1.5 mg/dl, preop K+ > 5 meq/L. Continuous veno-veno hemofiltration or hemodialysis was used. Replacement/dialysate fluid with 140Na⁺, 0K⁺, 35HCO₃^– was used in all cases. The default blood flow rate was 200ml/min, default replacement/dialysate fluid rate was 2400ml/hr and default ultrafiltration rate was 100ml/hr (adjusted per anesthesiologist). Renal function using serum Cr and measured glomerular filtration rate (GFR) was collected pre-transplant and at 1, 4, and 12 months post-transplant.

Results:Of the 667 recipients, 633 received LT only and 34 LKT. Of the 105 patients with ioRRT, 72 received LT alone and 33 LKT. 63/105 patients had preop RRT (60%). 55/105 required postop RRT (52%) while only 24/562 (4.4%) recipients without ioRRT required postop RRT (p < 0.001). Renal function is summarized in Table 1. Renal function was significantly worse in patients undergoing ioRRT at all times (p< .05). Survival at 1 year in those with ioRRT was 89.4% versus 93.9% in those without (p=0.12). At 1 year, survival in those with ioRRT undergoing postop RRT was 85.2% compared to 93.9% in those without (p=0.02). In patients without ioRRT, 1 year survival with postop RRT was 66.7% versus 95.1% without (p<0.001). In all patients requiring postop RRT, 1 year survival was 79.5% while those without had survival of 95% (p<0.001).

Conclusions:1) One year post transplant renal function in LT or LKT was significantly worse in those receiving ioRRT. 2) Patient survival at 1 year was equivalent in those with or without ioRRT if no postop RRT is needed. 3) Postop RRT adversely affects survival with current results improved over past reports.

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