Baek S D, Jang M, Kim W, Yu H, Hwang S, Lee S-G, Hwang G-S, Lee E K, Kim S M, Chang J W
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Nephrology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Transplant Proc. 2017 Jul-Aug;49(6):1344-1350. doi: 10.1016/j.transproceed.2017.03.094.
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 m).
Compared 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.
肝移植期间持续肾脏替代治疗的比较结果尚未得到研究。我们回顾性比较了肝移植术前肾功能不全患者术中持续肾脏替代治疗与非透析保守治疗的结果。
我们分析了240例术前肾功能不全（估计肾小球滤过率<60 mL/min/1.73 m²）的移植患者。
与非透析保守治疗组（n = 98）相比，术中持续肾脏替代治疗组（n = 142）的危重病况更严重（以终末期肝病模型评分表示），术前肾功能不全更严重，肝性脑病、通气护理和入住重症监护病房的情况也更频繁（P <.005）。在患者生存、移植物存活、肾功能恢复和术后并发症方面的结果也更差。然而，术中持续肾脏替代治疗组在术中显著避免了容量超负荷（调整后的优势比，0.396；95%置信区间，0.223 - 0.703；P =.002）以及血清钠浓度不必要的变化≥10 mmol/L（调整后的优势比，0.208；95%置信区间，0.065 - 0.665；P =.008）。
考虑到术中持续肾脏替代治疗组的危重病况更严重，但容量超负荷和血清钠波动的频率较低，术中持续肾脏替代治疗可能对肝移植术中合并肾功能不全的重症患者有用。需要进行随机对照研究以证明肝移植术中持续肾脏替代治疗的疗效益处和适应证。
