Zimmerman Michael A, Selim Motaz, Kim Joohyun, Regner Kevin, Saeian Kia, Zanowski Stephanie, Martin Alicia, Connolly Lois A, Lauer Kathryn K, Woehlck Harvey J, Hong Johnny C
Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI.
Surgery. 2017 May;161(5):1279-1286. doi: 10.1016/j.surg.2016.10.027. Epub 2016 Dec 20.
Orthotopic liver transplantation is the definitive treatment modality for patients with end-stage liver disease. Pre-orthotopic liver transplantation renal dysfunction has a significant negative influence on outcomes post-orthotopic liver transplantation. Intraoperative renal replacement therapy is an adjunctive therapy to address the metabolic challenges during orthotopic liver transplantation in patients with a high acuity of illness. The impact of intraoperative renal replacement therapy on post-orthotopic liver transplantation outcomes, however, is unclear.
From October of 2012 to April of 2016, 96 adult patients underwent orthotopic liver transplantation for end-stage liver disease. Three groups were identified: (1) Group I: patients with pre-orthotopic liver transplantation renal dysfunction who underwent intraoperative renal replacement therapy, (2) Group II: patients with pre-orthotopic liver transplantation renal dysfunction who did not receive intraoperative renal replacement therapy, and (3) Group III: patients with orthotopic liver transplantation without evidence of pretransplant renal dysfunction.
At 17.7 months follow-up, there was no difference in survival among the study groups. Physiologic model for end-stage liver disease at the time of orthotopic liver transplantation was significantly higher in both groups with renal dysfunction (I = 43, II = 39) than in Group III (18). Post-orthotopic liver transplantation, 12-month patient survival in Group II was 100%. While the model for end-stage liver disease score at orthotopic liver transplantation was significantly different between Group I and Group III, the 12-month, post-orthotopic liver transplantation patient survival was comparable at 78% vs 88%, respectively.
Intraoperative renal replacement therapy is a safe adjunctive therapy during liver transplantation of critically ill patients with renal dysfunction. Identifying patients who require intraoperative renal replacement therapy would improve intraoperative and post-liver transplant survival and may facilitate recovery of native kidney function after transplant.
原位肝移植是终末期肝病患者的确定性治疗方式。原位肝移植前的肾功能不全对原位肝移植后的结局有显著负面影响。术中肾脏替代治疗是一种辅助治疗方法，用于应对病情严重的患者在原位肝移植期间的代谢挑战。然而，术中肾脏替代治疗对原位肝移植后结局的影响尚不清楚。
2012年10月至2016年4月，96例成年患者因终末期肝病接受原位肝移植。分为三组：（1）第一组：原位肝移植前肾功能不全且接受术中肾脏替代治疗的患者；（2）第二组：原位肝移植前肾功能不全但未接受术中肾脏替代治疗的患者；（3）第三组：原位肝移植且无移植前肾功能不全证据的患者。
在17.7个月的随访中，各研究组的生存率无差异。肾功能不全的两组（第一组=43，第二组=39）原位肝移植时的终末期肝病生理模型均显著高于第三组（18）。原位肝移植后，第二组12个月的患者生存率为100%。虽然第一组和第三组原位肝移植时的终末期肝病评分模型有显著差异，但原位肝移植后12个月的患者生存率相当，分别为78%和88%。
术中肾脏替代治疗是肾功能不全重症患者肝移植期间的一种安全辅助治疗方法。识别需要术中肾脏替代治疗的患者将提高术中及肝移植后的生存率，并可能促进移植后天然肾功能的恢复。
