Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Liver Transpl. 2020 Aug;26(8):1010-1018. doi: 10.1002/lt.25773. Epub 2020 Jun 25.
Continuous renal replacement therapy (CRRT) is frequently used to treat recipients with renal failure before or after liver transplantation (LT), though evidence supporting its use during surgery remains unclear. Therefore, we conducted a quantitative meta-analysis to evaluate the effect of intraoperative continuous renal replacement therapy (IORRT) in recipients with pretransplant severe renal dysfunction. We searched PubMed, Embase, and the Cochrane database for trials focusing on LT recipients supported with or without IORRT. Outcomes assessed were mortality, preoperative characteristics, intraoperative data, and predefined postoperative outcomes. Seven trials with 1051 recipients were eligible. Preoperatively, the IORRT group recipients had higher Model for End-Stage Liver Disease scores (weighted mean difference [WMD], 6.19; 95% confidence interval [CI], 2.51-9.87), Charlson scores (WMD, 0.45; 95% CI, 0.09-0.80), acute liver failure (odds ratio [OR], 1.82; 95% CI, 1.27-2.61), serum creatinine (WMD, 71.33 μmol/L; 95% CI, 1.98-140.69 μmol/L), total bilirubin level (WMD, 5.05 μmol/L; 95% CI, 1.75-8.35 μmol/L), intensive care unit admission (OR, 3.53; 95% CI, 1.23-10.13), vasoactive therapy (OR, 3.80; 95% CI, 2.64-5.46), ventilator care (OR, 2.52; 95% CI, 1.18-5.35), and renal replacement therapy (RRT) (OR, 29.37; 95% CI, 7.66-112.54) compared with control patients. IORRT patients also required more intraoperative blood product transfusion and had more post-LT RRT (OR, 25.67; 95% CI, 4.92-133.85). However, there were no significant differences in short-term mortality (OR, 2.12; 95% CI, 0.82-5.44) between the groups. In addition, worse longterm mortality was seen in the IORRT group. In conclusion, IORRT is feasible and safe and may help sicker recipients tolerate the LT procedure to achieve short-term clinical outcomes comparable with less ill patients without IORRT. More high-quality evidence is needed to verify our conclusion in the future.
连续肾脏替代疗法（CRRT）常用于治疗肝移植（LT）前或后的肾衰竭患者，但支持其在手术期间使用的证据仍不清楚。因此，我们进行了一项定量荟萃分析，以评估术前严重肾功能障碍的接受者术中连续肾脏替代治疗（IORRT）的效果。我们检索了 PubMed、Embase 和 Cochrane 数据库，以查找关注接受者是否接受 IORRT 的 LT 试验。评估的结果是死亡率、术前特征、术中数据和预定的术后结果。有 7 项试验，共 1051 名接受者符合条件。术前，IORRT 组接受者的终末期肝病模型评分（加权均数差 [WMD]，6.19；95%置信区间 [CI]，2.51-9.87）、Charlson 评分（WMD，0.45；95%CI，0.09-0.80）、急性肝衰竭（比值比 [OR]，1.82；95%CI，1.27-2.61）、血清肌酐（WMD，71.33μmol/L；95%CI，1.98-140.69μmol/L）、总胆红素水平（WMD，5.05μmol/L；95%CI，1.75-8.35μmol/L）、入住重症监护病房（OR，3.53；95%CI，1.23-10.13）、血管活性治疗（OR，3.80；95%CI，2.64-5.46）、呼吸机护理（OR，2.52；95%CI，1.18-5.35）和肾脏替代治疗（RRT）（OR，29.37；95%CI，7.66-112.54）均高于对照组。与对照组相比，IORRT 患者还需要更多的术中血液制品输注，并在 LT 后需要更多的 RRT（OR，25.67；95%CI，4.92-133.85）。然而，两组之间的短期死亡率（OR，2.12；95%CI，0.82-5.44）无显著差异。此外，IORRT 组的长期死亡率更差。总之，IORRT 是可行和安全的，它可以帮助病情较重的接受者耐受 LT 手术，以获得与未接受 IORRT 的病情较轻的患者相当的短期临床结果。未来需要更多高质量的证据来验证我们的结论。
