title: Anesthetic support in synchronous liver and kidney transplantation.
abstract: OBJECTIVE
  We performed a retrospective evaluation of 11 patients in the final stages of hepatic disease with chronic kidney failure, in whom simultaneous double liver-kidney transplantation was performed.
  
  
  METHODS
  In the immediate pre-, intra- and postoperative periods, we assessed metabolic, hemodynamic and coagulation parameters; bicarbonate, calcium and inotropic drug requirements; the incidences during reperfusion of the graft; the surgical technique employed; the need for hemodialysis and/or ultrafiltration; and the survival rate of the patients.
  
  
  RESULTS
  Of the 11 cases studied, four patients needed hemodialysis, while only one patient needed ultrafiltration; three patients required both techniques, and no dialysis or ultrafiltration was performed in three patients. The following surgical techniques were employed: Total clamping of the inferior vena cava using an external venovenous bypass in two cases; total clamping of the inferior vena cava without an external venovenous bypass in three cases; and partial clamping of the inferior vena cava with preservation of the retrohepatic cava in six cases. The results showed one death in the first postoperative month and two deaths in the course of subsequent follow-up. The survival rate was 72.7%.
  
  
  CONCLUSIONS
  The use of conventional intraoperative hemodialysis and/or ultrafiltration is feasible, useful and achieves good results in patients undergoing double liver-kidney transplantation. Partial clamping of the inferior vena cava at the anhepatic stage appears to reduce the need for ultrafiltration. There is no increase in perioperative mortality in patients who underwent liver transplantation while conserving their renal function.
authors.affiliation: Service of Anesthesia and Reanimation, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Perez-Cerda
authors.forename: E
authors.initials: E
authors.lastname: Moreno Gonzalez
authors.forename: A S
authors.initials: AS
authors.lastname: de Bobadilla
authors.forename: I
authors.initials: I
authors.lastname: Garcia Garcia
authors.forename: M
authors.initials: M
authors.lastname: Cortes Guerrero
authors.forename: R
authors.initials: R
authors.lastname: Gomez Sanz
authors.forename: I
authors.initials: I
authors.lastname: del Campo Sanchez
authors.forename: C
authors.initials: C
authors.lastname: Loinaz Segurola
authors.forename: A
authors.initials: A
authors.lastname: Martinez de Guerenu
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D008107:Liver Diseases / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies