Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
Adv Med Sci. 2022 Sep;67(2):208-215. doi: 10.1016/j.advms.2022.04.004. Epub 2022 May 11.
Over the last few years, transplant centers have started to use various intraoperative renal replacement therapy (ioRRT) modalities during liver transplantation (LT) in patients with pre-existing renal impairment. Here, we present a study on the safety and clinical outcomes of intraoperative hemodialysis (ioHD) performed using a mobile dialysis system during LT.
We retrospectively analyzed 102 adult patients undergoing LT with ioHD; pre-existing renal failure and/or intraoperative metabolic derangement were ioHD treatment indications.
Our study cohort consisted of three groups: LT with preoperative serum creatinine (sCr) < 2 mg/dL (Group 1:n = 22), LT with preoperative sCr ≥2 mg/dL (Group 2:n = 73), and simultaneous liver-kidney transplantation (Group 3:n = 7). Among the procedures, 30% were re-transplantations. The mean calculated Model for End-stage Liver Disease score in Group 2 was 39.2, and 67% of patients were hospitalized in the intensive care unit. Patients in Group 1 were less acutely ill but developed severe intraoperative derangements and, therefore, underwent urgent ioHD intraoperatively. However, it was delayed when compared to Group 2. All groups achieved post-reperfusion potassium levels <4 mmol/L and a decrease in central venous pressure. No serious procedural complications occurred. Post-reperfusion syndrome occurred in 12.7% of patients. Elevated mortality was likely due to the high illness severity in the cohort.
Performing ioHD with a mobile dialysis system during LT was safe and effective, while being easier to perform than continuous techniques. Its effect on intra- and postoperative outcomes should be addressed in a study with a control group.
在过去的几年中，移植中心开始在存在预先存在的肾功能损害的患者中在肝移植 (LT) 期间使用各种术中肾脏替代治疗 (ioRRT) 方式。在这里，我们介绍了在 LT 期间使用移动透析系统进行术中血液透析 (ioHD) 的安全性和临床结果的研究。
我们回顾性分析了 102 例接受 ioHD 的成人 LT 患者；预先存在的肾衰竭和/或术中代谢紊乱是 ioHD 治疗的指征。
我们的研究队列包括三组：术前血清肌酐 (sCr) < 2 mg/dL 的 LT (组 1：n = 22)、术前 sCr ≥2 mg/dL 的 LT (组 2：n = 73) 和同时进行的肝-肾移植 (组 3：n = 7)。在这些手术中，有 30%是再次移植。组 2 的平均计算的终末期肝病模型评分为 39.2，67%的患者住院于重症监护病房。组 1 的患者病情较轻，但术中出现严重的代谢紊乱，因此需要紧急进行术中 ioHD。但是与组 2 相比，时间上有所延迟。所有组均在再灌注后达到血钾水平 <4 mmol/L 和中心静脉压降低。没有发生严重的程序并发症。再灌注后综合征发生在 12.7%的患者中。高死亡率可能是由于该队列中患者的疾病严重程度较高所致。
在 LT 期间使用移动透析系统进行 ioHD 是安全有效的，而且比连续技术更容易进行。在具有对照组的研究中，应该探讨其对术中及术后结果的影响。
