Effects of surgical technique on postoperative renal function after orthotopic liver transplant.
OBJECTIVE
The classic technique for orthotopic liver transplant consists of the total excision of the retrohepatic inferior vena cava during native hepatectomy. Controversy about the effects of the classic technique on postoperative renal function continues. The aim of this study was to evaluate the effects of the chosen hepatectomy technique on postoperative renal function.


METHODS
Of 253 patients who received an orthotopic liver transplant between June 2006 and July 2008 in the Shiraz transplant unit, only 15 underwent operation with the classic technique. Patient demographics and factors including cold ischemic time, warm ischemic time, operative time, transfusions, blood loss, and early postoperative renal function were assessed retrospectively. The criteria for acute renal failure were a serum creatinine level of > 133 micromol/L (1.5 mg/dL), an increase in the baseline serum creatinine level by 50%, or oliguria requiring renal replacement therapy.


RESULTS
All patients received a liver from a deceased donor, and none required venovenous bypass during the operation. The minimum mean arterial blood pressure value of the patients during clamping was 65 -/+ 19 mm Hg. The mean preoperative plasma creatinine level was 87.51 -/+ 39.78 micromol (0.99 -/+ 0.45 mg/dL). During the first week after transplant, 7 patients (46.6%) experienced acute renal failure, and 3 of those 7 required renal replacement therapy. By the sixth postsurgical month, 4 of those 7 patients had died (1 from adult respiratory distress syndrome, 2 from sepsis, and 1 from recurrent cholangiocarcinoma). In all other patients, the plasma creatinine level had returned to the normal range by the third postsurgical week 3 or during short-term follow-up.


CONCLUSIONS
Use of the classic technique for orthotopic liver transplant may increase the rate of postoperative renal failure, but that complication usually resolves during short-term follow-up.
Shiraz Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Saman
S
Nikeghbalian
Masood
M
Dehghani
Heshmatollah
H
Salahi
Ali
A
Bahador
Kourosh
K
Kazemi
Farzad
F
Kakaei
Elnaz
E
Rajaei
Siavosh
S
Gholami
Seyed Ali
SA
Malek-Hosseini
D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000209:etiology; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery
D003404:Creatinine