Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Curr Opin Organ Transplant. 2011 Jun;16(3):323-5. doi: 10.1097/MOT.0b013e328346c8a2.
Orthotopic liver transplant (OLT) is a major surgical procedure that can be both challenging and lengthy. One of the common findings in end-stage liver disease is renal failure, whether acute or chronic, which may complicate the intraoperative course.
The use of intraoperative hemodialysis is described by several centers to aid during OLT cases with impaired renal function or kidney failure. Unfortunately, there is a paucity of available data, which is limited to sporadic case reports, and only few structured studies in which continuous renal replacement therapy was used versus intraoperative hemodialysis, which is the main focus of this article. The rationale behind the use of intraoperative hemodialysis during OLT in patients with kidney dysfunction or failure is that the procedure is usually complicated by major hemodynamic changes, metabolic derangement, and coagulation abnormalities, which we think can be better managed intraoperatively using hemodialysis. In our institution, we performed over 140 cases of OLT using intraoperative hemodialysis since 2003 until the present. A retrospective cohort study is being conducted during the writing of this article. Preliminary data collection report zero percentage intraoperative mortality and 48 h postoperatively.
Hemodialysis is widely acknowledged as a treatment option to stabilize patients with renal failure, and one of the most challenging situations is during OLT in which the role of intraoperative hemodialysis is becoming more important today more than ever before.
原位肝移植（OLT）是一项重大的外科手术，既具有挑战性又耗时较长。终末期肝病的常见表现之一是急性或慢性肾功能衰竭，这可能会使手术过程复杂化。
一些中心描述了术中血液透析的使用，以帮助肾功能受损或肾衰竭的 OLT 病例。不幸的是，可用数据很少，仅限于零星的病例报告，只有少数结构研究使用了连续性肾脏替代治疗与术中血液透析，这是本文的主要重点。在肾功能障碍或衰竭的患者中，在 OLT 期间使用术中血液透析的基本原理是，该手术通常会引起重大的血液动力学变化、代谢紊乱和凝血异常，我们认为术中使用血液透析可以更好地进行管理。自 2003 年以来，我们所在的机构在超过 140 例 OLT 中使用了术中血液透析，直到现在。在撰写本文时，我们正在进行一项回顾性队列研究。初步数据收集报告显示，术中死亡率为零，术后 48 小时死亡率为零。
血液透析被广泛认为是治疗肾衰竭患者的一种选择，在 OLT 中，血液透析的作用变得越来越重要，这是最具挑战性的情况之一。
