Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.
Department of Surgery, University of California, San Francisco, CA.
Transplantation. 2018 May;102(5):e229-e235. doi: 10.1097/TP.0000000000002137.
Renal failure is common among patients undergoing liver transplantation. Liver allocation based on the model for end-stage liver disease score has increased the number of recipients who require perioperative renal replacement therapy (RRT). Although RRT can be continued intraoperatively, the risks and benefits of intraoperative RRT are not well defined. The aim of this study is to report the intraoperative management of patients with pretransplant renal failure at a transplant center with extremely infrequent utilization of intraoperative RRT.
We performed a retrospective analysis of all adult patients undergoing orthotopic liver or simultaneous liver-kidney (SLK) transplantation between June 2009 and December 2015. Patients were divided into 2 groups based on their need for pretransplant RRT.
A total of 785 patients underwent liver or SLK transplant during the study period. One hundred and seventy-four patients (22.2%) required preoperative dialysis. Only 2 patients required intraoperative RRT. There was no difference in the incidence of acidosis or hyperkalemia between patients who required preoperative dialysis and those who did not.
We describe the successful management of patients undergoing liver or SLK transplantation almost entirely without the need for intraoperative RRT.
肾衰竭在接受肝移植的患者中很常见。基于终末期肝病模型评分的肝分配增加了需要围手术期肾脏替代治疗（RRT）的受者数量。虽然可以在手术期间继续进行 RRT，但手术期间 RRT 的风险和益处尚未得到很好的定义。本研究的目的是报告在一个很少使用手术期间 RRT 的移植中心，对移植前肾衰竭患者的术中管理。
我们对 2009 年 6 月至 2015 年 12 月期间所有接受原位肝或同时肝-肾（SLK）移植的成年患者进行了回顾性分析。根据患者术前是否需要 RRT，将患者分为两组。
研究期间共 785 例患者接受肝或 SLK 移植。174 例（22.2%）患者需要术前透析。仅 2 例患者需要术中 RRT。需要术前透析的患者与不需要术前透析的患者酸中毒或高钾血症的发生率无差异。
我们描述了成功管理几乎完全不需要术中 RRT 的肝或 SLK 移植患者。
