title: An evaluation of intraoperative renal support during liver transplantation: a matched cohort study.
abstract: BACKGROUND
  Intraoperative continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT). Our objective was to assess intraoperative CRRT for metabolic control, postoperative complications and outcomes.
  
  
  METHODS
  Retrospective matched cohort study. Cases were LT patients receiving intraoperative CRRT. Controls were matched for demographics and Model for End-Stage Liver Disease (MELD) score. Data were extracted on physiology, course and outcomes.
  
  
  RESULTS
  72 patients were included. Despite effort to match by MELD, cases had higher scores (35.4 vs. 29.9, p = 0.01) compared to controls. Preoperatively, cases received more vasopressors (p = 0.006), and more RRT (94.4 vs. 25.7%, p < 0.0001). There was no difference in complications (p = 0.35) or ICU re-admission rate (p = 0.29). Cases were more likely to require postoperative RRT (p < 0.0001). There was no difference in hospital mortality (p = 0.61).
  
  
  CONCLUSIONS
  LT patients selected for intraoperative CRRT more commonly have hemodynamic instability and preoperative acute kidney injury requiring RRT. Despite higher illness severity for cases, there were no differences in complications or mortality.
authors.affiliation: Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Ambica
authors.initials: A
authors.lastname: Parmar
authors.forename: David
authors.initials: D
authors.lastname: Bigam
authors.forename: Glenda
authors.initials: G
authors.lastname: Meeberg
authors.forename: Dominic
authors.initials: D
authors.lastname: Cave
authors.forename: Derek R
authors.initials: DR
authors.lastname: Townsend
authors.forename: R T Noel
authors.initials: RT
authors.lastname: Gibney
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D014184:Transplantation, Homologous