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Intraoperative hemodialysis during liver transplantation

The latest issue of Liver Transplantation describes the safety and clinical outcomes of intraoperative hemodialysis during liver transplantation for a group of patients with high MELD scores.

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Liver transplantation for patients with renal dysfunction is frequently complicated by major fluid shifts, acidosis, and electrolyte and coagulation abnormalities.

Continuous renal replacement therapy has been previously shown to ameliorate these problems.

Dr Mitra Nadim and colleagues from California, USA described the safety and clinical outcomes of intraoperative hemodialysis during liver transplantation for a group of patients with high Model for End-Stage Liver Disease (MELD) scores.

The researchers performed a retrospective study at our institution of patients who underwent intraoperative hemodialysis from 2002 to 2012.

The 90-day patient survival rates were 90%
Liver Transplantation

The team reported that 737 patients underwent transplantation, and 32% received intraoperative hemodialysis.

The mean calculated MELD score was 37, with 38% having a MELD score ≥ 40.

Preoperatively, 61% were in the intensive care unit, 19% were mechanically ventilated, 43% required vasopressor support, and 80% were on some form of renal replacement therapy at the time of transplantation, the majority being on continuous renal replacement therapy .

Patients on average received 35 U of blood products and 4.8 L of crystalloids without significant changes in hemodynamics or electrolytes.

The average urine output was 450 ml, and the average amount of fluid removal with dialysis was 1.8 L.

The team found that the 90-day patient and dialysis-free survival rates were 90% and 99%, respectively.

The research team observed that 1-year patient survival rates based on the pretransplant renal replacement status and the MELD status were not statistically different.

Dr Nadim's team comments, "This is the first large study to demonstrate the safety and feasibility of intraoperative hemodialysis in a cohort of critically ill patients with high MELD scores undergoing liver transplantation with good patient and renal outcomes."

Liver Transplant 2014: 20(7): 756–764
02 July 2014

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