Wi Wongook, Hahm Tae Soo, Kim Gaab-Soo
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea.
Korean J Anesthesiol. 2017 Aug;70(4):467-476. doi: 10.4097/kjae.2017.70.4.467. Epub 2017 Apr 21.
Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Recipients of SLKT tend to have a lower pre-transplant kidney function and the longer operation time mandates a larger amount of fluid than LT alone. Hence, anesthetic care is more prone to be challenged by hyperkalemia, metabolic acidosis, and volume overload, making ioRRT a theoretically valuable intervention. However, in all five cases, recipients were managed without ioRRT, resulting in excellent graft and patient survival. As such, in this case series, we discuss current issues about ioRRT and SLKT.
自2002年实施终末期肝病模型（MELD）评分系统以来，肝移植（LT）界观察到肾功能不全受者的数量大幅增加。术中肾脏替代治疗（ioRRT）已成为管理高MELD评分受者的可用解决方案之一；然而，其有效性尚未得到证实。迄今为止，我们已经历了5例肝肾联合移植（SLKT）病例。SLKT受者移植前肾功能往往较低，且手术时间较长，所需液体量比单纯肝移植更大。因此，麻醉管理更容易受到高钾血症、代谢性酸中毒和容量超负荷的挑战，这使得ioRRT在理论上成为一种有价值的干预措施。然而，在所有5例病例中，受者均未接受ioRRT治疗，结果移植物和患者存活率良好。因此，在本病例系列中，我们讨论了有关ioRRT和SLKT的当前问题。
