Kidney failure associated with liver transplantation or liver failure: the impact of continuous veno-venous hemofiltration.
OBJECTIVE
The short-term outcome of critically ill patients with kidney failure combined with severe liver failure or orthotopic liver transplantation (OLTx) is poor. We sought to test the hypothesis that, with the exclusive use of continuous veno-venous hemofilration (CVVH) with minimal heparin-anticoagulation, the short and long-term outcomes of these patients would be improved.


METHODS
Sixty-six consecutive patients with combined liver and kidney failure


METHODS
Intensive Care Unit of tertiary hospital


METHODS
Retrospective interrogation of prospectively collected databases


METHODS
Treatment of all patients with continuous veno-venous hemofiltration (CVVH) by protocol with 2L/h of ultrafiltration rate and minimal use of circuit heparinization. Retrieval of specific information on demographic, clinical, therapeutic and outcome details.


RESULTS
From July 1995 to April 2004, 66 patients with combined liver and renal failure received continuous veno-venous hemofiltration (CVVH). Of these, 26 received liver transplantation and 40 did not. There were no significant differences in age, APACHE II score, bilirubin, ALT, INR or albumin on admission. The average duration of CVVH was 9.5 days for OLTx patients and 5 days for non-transplanted patients (p=0.013). Heparin anticoagulation was used in only 12% of OLTx patients and 20% of non-transplanted patients. ICU mortality was 15% in OLTx patients and 63% in non-transplanted patients (p<0.0005); hospital mortality was 23% compared to 70% (p<0. 001). Mean survival time at follow up was 1,120 days compared to 358 days (p<0.0001).


CONCLUSIONS
ARF associated with OLTx has a much better outcome than ARF without OLTx. Furthermore, management based on a conservative anticoagulation policy and CVVH as the exclusive form of renal support was associated with the best ICU, hospital and long term survival reported so far.
Naka
T
T
Department of Intensive Care and Surgery, Austin Hospital, Melbourne, Australia.
Wan
L
L
Bellomo
R
R
Wang
B Zong
BZ
Jones
R
R
Berry
R
R
Angus
P
P
Gow
P
P
D002423:Cause of Death; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D011336:Probability; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome