title: The impact of renal replacement therapy before or after living donor liver transplantation.
abstract: BACKGROUND
  The impact of renal replacement therapy (RRT) in living donor liver transplantation (LDLT) has not yet been investigated.
  
  
  METHODS
  Among 253 LDLT patients, RRT was started before (RRT-Pre, n = 9), or after (RRT-Post, n = 27) LDLT. The clinical outcomes were reviewed.
  
  
  RESULTS
  The one-yr graft survival rate was 94.1% without RRT, and 63.9% and in those with RRT (p < 0.0001). Among the RRT patients, the RRT-Pre patients exhibited acute liver failure, hepatorenal syndrome and high model for end-stage liver disease score (35 ± 12), whereas the RRT-Post patients had sepsis as a comorbidity. The one-yr graft survival rate was 100.0% in the RRT-Pre patients vs. 51.9% in the RRT-Post patients (p < 0.01). The duration of RRT was significantly shorter in the RRT-Pre patients than that in the RRT-Post patients (5.3 ± 2.1 vs. 17.8 ± 14.1 d, p = 0.02). The mean duration between starting RRT and LDLT was 2.1 ± 0.7 d in the Pre-RRT patients.
  
  
  CONCLUSIONS
  The RRT-Pre patients had excellent outcomes because the severe condition was primarily treated by LDLT after short-term pre-transplant RRT. Post-transplant uncontrollable sepsis was the major cause of graft loss in patients who receive RRT after LDLT.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
authors: Toru
authors: T
authors: Ikegami
authors: Ken
authors: K
authors: Shirabe
authors: Yuji
authors: Y
authors: Soejima
authors: Akinobu
authors: A
authors: Taketomi
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Hideaki
authors: H
authors: Uchiyama
authors: Noboru
authors: N
authors: Harada
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy / Q000401:mortality*; D015996:Survival Rate