Benefits of Intraoperative Continuous Renal Replacement Therapy During Liver Transplantation in Patients With Renal Dysfunction
| Autor: | Gyu-Sam Hwang, Seung Don Baek, Mun Jang, Sung-Gyu Lee, So Mi Kim, Hoon Yu, Sang-Hyun Hwang, Jo Won Chang, Won Young Kim, Eun Kyoung Lee |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Nephrology medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology Renal function Liver transplantation Kidney urologic and male genital diseases law.invention 03 medical and health sciences Liver disease 0302 clinical medicine law Internal medicine Odds Ratio medicine Humans Renal Insufficiency Renal replacement therapy Aged Retrospective Studies Transplantation Intraoperative Care business.industry Liver Diseases Middle Aged medicine.disease Intensive care unit Liver Transplantation Surgery Renal Replacement Therapy Treatment Outcome medicine.anatomical_structure Female 030211 gastroenterology & hepatology business Glomerular Filtration Rate |
| Zdroj: | Transplantation Proceedings. 49:1344-1350 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2017.03.094 |
| Popis: | Comparative outcomes of continuous renal replacement therapy during liver transplantation have not been investigated. We retrospectively compared the outcomes of intraoperative continuous renal replacement therapy with those of non-dialytic conservative treatment in patients with pretransplant renal dysfunction.We analyzed 240 transplantation patients with preoperative renal dysfunction (estimated glomerular filtration rate 60 mL/min/1.73 mCompared with the non-dialytic conservative treatment group (n = 98), the intraoperative continuous renal replacement therapy group (n = 142) experienced more severe critical illness (as indicated by Model for End-Stage Liver Disease score) and more severe preoperative renal dysfunction, as well as more frequent hepatic encephalopathy, ventilatory care, and intensive care unit admission (P .005). There were also worse outcomes regarding patient survival, graft survival, recovery of renal function, and postoperative complications. However, the intraoperative continuous renal replacement therapy group significantly escaped volume overload (adjusted odds ratio, 0.396; 95% confidence interval, 0.223-0.703; P = .002) and unnecessary changes in serum sodium concentration ≥10 mmol/L during surgery (adjusted odds ratio, 0.208; 95% confidence interval, 0.065-0.665; P = .008).Considering the more severe critical illness of the intraoperative continuous renal replacement therapy group but the low frequency of volume overload and serum sodium fluctuation, intraoperative continuous renal replacement therapy could be useful during liver transplantation in critically ill patients with renal dysfunction. Randomized, controlled studies that could demonstrate outcome benefits and indications of intraoperative continuous renal replacement therapy during liver transplantation are needed. |
| Databáze: | OpenAIRE |
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