Intraoperative Dialysis During Liver Transplantation
| Autor: | Małgorzata Kościelska, Dorota Giercuszkiewicz, Paweł Żebrowski, Krzysztof Zieniewicz, Jolanta Malyszko, Janusz Sierdziński, Joanna Matuszkiewicz-Rowińska, Marek Krawczyk |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Liver transplantation law.invention chemistry.chemical_compound Renal Dialysis law medicine Humans Renal replacement therapy Kidney transplantation Dialysis Retrospective Studies Transplantation Creatinine business.industry Retrospective cohort study Middle Aged medicine.disease Kidney Transplantation Intensive care unit Liver Transplantation Surgery chemistry Reperfusion Injury Reperfusion Female business |
| Zdroj: | Transplantation Proceedings. 52:2454-2458 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2020.01.129 |
| Popis: | Background Orthotopic liver transplantation (LT) is a technically complex surgical procedure associated with a major risk of hemodynamic instability and metabolic derangement, especially in patients with coexisting renal dysfunction. Some centers have applied intraoperative renal replacement therapy (ioRRT) to support patients with preoperative renal failure and prevent critical complications. Although there is a strong theoretical rationale for this treatment, there remains a paucity of definite data demonstrating its benefits. Methods This was a retrospective observational study of all adult patients undergoing intraoperative dialysis in our center from January 2010 till December 2016. Results The study group consisted of 88 patients with a mean MELD score of 31.4. Six patients underwent simultaneous liver and kidney transplantation. Forty-four (50%) recipients were admitted to the intensive care unit before transplantation, and 19 (21.6%) needed mechanical ventilation. Twenty-eight (31.8%) of the procedures were retransplantations, and 40 (45.4%) patients had been undergoing renal replacement therapy before LT. The mean preoperative serum creatinine was 2.82 ± 1.13 mg/dL. The majority of patients (54.5%) was operated on using the veno-venous bypass technique. The mean arterial blood pH and potassium levels after reperfusion were 7.2 ± 0.12 and 4.04 ± 0.95 mmol/L, respectively. Postreperfusion syndrome (PRS) occurred in 11 (13.9%) patients in whom dialysis started at least 15 minutes before reperfusion. Dialysis circuit clotting occurred in 9.1% of cases. There were no other adverse events of ioRRT. Conclusion Our data suggests that intraoperative dialysis in severely ill patients with a high MELD score is safe and effective. Lower than expected PRS occurrence needs to be confirmed in a study with a control group. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect