[Prophylaxis and management of early acute renal failure after orthotopic liver transplantation].

OBJECTIVE

To summarize the experiences of prophylaxis and management of early period acute renal failure (ARF) after orthotopic liver transplantation (OLTx).

METHODS

The clinical data of 516 patients from January 2004 to December 2006 at our hospital undergoing allograft orthotopic liver transplantation, 418 males and 98 females, aged 43 (8-76) years old, were collected to analyze the incidence of early ARF.

RESULTS

Of these patients, 106 (20.5%)experienced early ARF, including 21 mild, 40 moderate and 45 severe cases. The integrated control treatment including retrieving prerenal factors, adjusting immunosuppressive schedule, drug therapy and blood purification were taken to cure ARF and 21 patients of severe ARF needed continuous renal replacement therapy (CRRT). Of 106 patients, 37 (34.9%) died within 1 month post-OLT. The one month post-OLT survival rate of patients with MELD (model for end-stage liver disease) score less than 20 fared better than those whose MELD score between 20 to 30 and MELD score over 30.

CONCLUSION

The prophylaxis and management of early post-OLT ARF is a systemic procedure from preoperative assessment to postoperative management. The significant steps of preventing and curing ARF within perioperative procedure of OLTx include preoperative evaluation of patient renal function, various intra-operative measures for protecting renal function, reducing renal function impairment due to drug toxicity after OLT and CRRT treatment if needed.