Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
Blood Purif. 2011;32(3):238-48. doi: 10.1159/000329485. Epub 2011 Aug 9.
Intraoperative continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT). Our objective was to assess intraoperative CRRT for metabolic control, postoperative complications and outcomes.
Retrospective matched cohort study. Cases were LT patients receiving intraoperative CRRT. Controls were matched for demographics and Model for End-Stage Liver Disease (MELD) score. Data were extracted on physiology, course and outcomes.
72 patients were included. Despite effort to match by MELD, cases had higher scores (35.4 vs. 29.9, p = 0.01) compared to controls. Preoperatively, cases received more vasopressors (p = 0.006), and more RRT (94.4 vs. 25.7%, p < 0.0001). There was no difference in complications (p = 0.35) or ICU re-admission rate (p = 0.29). Cases were more likely to require postoperative RRT (p < 0.0001). There was no difference in hospital mortality (p = 0.61).
LT patients selected for intraoperative CRRT more commonly have hemodynamic instability and preoperative acute kidney injury requiring RRT. Despite higher illness severity for cases, there were no differences in complications or mortality.
术中持续肾脏替代治疗（CRRT）已在肝移植（LT）中得到应用。我们的目的是评估术中 CRRT 在代谢控制、术后并发症和结局方面的作用。
回顾性匹配队列研究。病例为接受术中 CRRT 的 LT 患者。对照组按人口统计学和终末期肝病模型（MELD）评分匹配。提取生理、病程和结局数据。
共纳入 72 例患者。尽管努力按 MELD 评分匹配，但病例组的评分（35.4 对 29.9，p = 0.01）仍高于对照组。术前，病例组接受了更多的血管加压药（p = 0.006）和更多的 RRT（94.4 对 25.7%，p < 0.0001）。并发症（p = 0.35）或 ICU 再入院率（p = 0.29）无差异。病例组更有可能需要术后 RRT（p < 0.0001）。住院死亡率无差异（p = 0.61）。
选择术中 CRRT 的 LT 患者更常出现血流动力学不稳定和术前急性肾损伤需要 RRT。尽管病例组疾病严重程度更高，但并发症或死亡率无差异。
