title: [Intraoperative anesthetic management of kidney failure in adult liver transplantation. Conventional hemodialysis].
abstract: OBJECTIVE
  To evaluate our application of indications, use and benefits of conventional hemodialysis during surgery in patients with advanced liver disease and acute or chronic renal failure undergoing liver transplantation (LP), liver retransplantation (LRT) or combined hepatorenal transplantation (CHRT).
  
  
  METHODS
  We retrospectively reviewed the cases of 22 patients with advanced liver disease, 11 with acute renal failure and 11 with chronic renal failure. We performed 6 LT, 5 LRT and 11 CHRT. The following data were recorded in the periods before, during and immediately after surgery: metabolic, hemodynamic and coagulation parameters; bicarbonate, calcium and inotropic drug requirements; incidences during reperfusion of the graft; surgical technique used; and survival.
  
  
  RESULTS
  Seven patients (32%) needed hemodialysis, 4 (18%) needed ultrafiltration, 7 (32%) needed both and 4 (18%) required neither. For 6 patients total clamping of the inferior vena cava (ICV) was required with external venovenous bypass. For 8 patients total clamping of the IVC was performed without venovenous bypass. For 8 others IVC clamping was partial with retrohepatic preservation (piggy-back). There were 2 deaths during surgery, 4 more within the first month after surgery and 4 more in the second month. Overall survival was 36.4% among acute patients and 72.7% among CHRT patients.
  
  
  CONCLUSIONS
  1) Conventional hemodialysis during surgery is feasible and gives good results; 2) conventional "high efficiency" hemodialysis is more effective and useful in these patients than is either slow, continuous hemodialysis or filtration; 3) the survival rate of CHRT patients is similar to that of patients undergoing LT with normal kidney function, and 4) partial IVC clamping in the anhepatic phase may decrease the need for ultrafiltration.
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid.
authors.forename: A
authors.initials: A
authors.lastname: Sevillano
authors.forename: F
authors.initials: F
authors.lastname: Pérez-Cerdá
authors.forename: J F
authors.initials: JF
authors.lastname: Muñoz
authors.forename: M
authors.initials: M
authors.lastname: Cortés
authors.forename: I
authors.initials: I
authors.lastname: del Campo
authors.forename: P
authors.initials: P
authors.lastname: Dávila
authors.forename: R
authors.initials: R
authors.lastname: Gómez
authors.forename: I
authors.initials: I
authors.lastname: García
authors.forename: E
authors.initials: E
authors.lastname: Moreno
mesh_terms: D000759:Adjuvants, Anesthesia; D000293:Adolescent; D000328:Adult; D000769:Anesthesia, Inhalation; D003250:Constriction; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000401:mortality; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications; D017093:Liver Failure / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011183:Postoperative Complications / Q000401:mortality; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D014682:Vena Cava, Inferior
chemical_list: D000759:Adjuvants, Anesthesia; D003473:Neuromuscular Nondepolarizing Agents
vernacular_title: Manejo anestésico intraoperatorio del fallo renal en el trasplante hepático del adulto. Hemodiálisis convencional.