Advances in TransplantationLiver transplantationBenefits of Intraoperative Continuous Renal Replacement Therapy During Liver Transplantation in Patients With Renal Dysfunction

•LT patients who underwent intraoperative CRRT showed high disease severity scores.•The use of intraoperative CRRT in severely ill LT candidates had the benefits of avoiding perioperative volume excess and wide fluctuations in sodium concentration.•Prospective randomized, controlled trials could reveal the risks and benefits of intraoperative CRRT during LT more clearly.

BackgroundComparative outcomes of continuous renal replacement therapy during liver transplantation have not been investigated. We retrospectively compared the outcomes of intraoperative continuous renal replacement therapy with those of non-dialytic conservative treatment in patients with pretransplant renal dysfunction.MethodsWe analyzed 240 transplantation patients with preoperative renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2).ResultsCompared with the non-dialytic conservative treatment group (n = 98), the intraoperative continuous renal replacement therapy group (n = 142) experienced more severe critical illness (as indicated by Model for End-Stage Liver Disease score) and more severe preoperative renal dysfunction, as well as more frequent hepatic encephalopathy, ventilatory care, and intensive care unit admission (P < .005). There were also worse outcomes regarding patient survival, graft survival, recovery of renal function, and postoperative complications. However, the intraoperative continuous renal replacement therapy group significantly escaped volume overload (adjusted odds ratio, 0.396; 95% confidence interval, 0.223-0.703; P = .002) and unnecessary changes in serum sodium concentration ≥10 mmol/L during surgery (adjusted odds ratio, 0.208; 95% confidence interval, 0.065-0.665; P = .008).ConclusionsConsidering the more severe critical illness of the intraoperative continuous renal replacement therapy group but the low frequency of volume overload and serum sodium fluctuation, intraoperative continuous renal replacement therapy could be useful during liver transplantation in critically ill patients with renal dysfunction. Randomized, controlled studies that could demonstrate outcome benefits and indications of intraoperative continuous renal replacement therapy during liver transplantation are needed.