title: Efficacy and safety of regional citrate anticoagulation in liver transplant patients requiring post-operative renal replacement therapy.
abstract: BACKGROUND
  Liver transplant patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) early post-operatively are at high risk for bleeding. Using heparin for anticoagulation during CRRT may contribute to the increased bleeding risk. Regional anticoagulation with citrate may decrease the risk of bleeding. However, citrate anticoagulation may be associated with metabolic complications in patients with liver impairment. The aim of the study was to evaluate the safety and efficacy of citrate anticoagulation in liver transplant patients.
  
  
  METHODS
  All liver transplant recipients transplanted between November 2004 and August 2007, requiring CRRT and using citrate as the anticoagulant were included in this retrospective study. Demographic data, CRRT specific and metabolic data were collected and analysed.
  
  
  RESULTS
  Sixty-eight patients (40 male/28 female) with a mean age of 47.1±11.8 years and a Model of End-stage Liver Disease score of 23±9 developed post-operative AKI requiring CRRT using citrate as the anticoagulant. The median duration on CRRT was 8 days (range 1-39 days) with a mean circuit life of 22.7±14.6 h. There was no relevant time trend of serum sodium, potassium, calcium, bicarbonate and pH values during CRRT. Bleeding occurred in 8 of 68 (11.7%) patients during CRRT.
  
  
  CONCLUSIONS
  Regional citrate anticoagulation for CRRT in the early post-operative period after liver transplantation is effective and safe. Therefore, the general exclusion of citrate anticoagulation during CRRT in patients after liver transplantation is not justified.
authors: Department of General, Visceral and Transplant Surgery, University Hospital Essen, Unversity Duisburg-Essen, Essen, Germany. fuat.saner@uni-due.de
authors: Fuat H
authors: FH
authors: Saner
authors: Juergen W
authors: JW
authors: Treckmann
authors: Alexander
authors: A
authors: Geis
authors: Christian
authors: C
authors: Lösch
authors: Oliver
authors: O
authors: Witzke
authors: Ali
authors: A
authors: Canbay
authors: Stephan
authors: S
authors: Herget-Rosenthal
authors: Andreas
authors: A
authors: Kribben
authors: Andreas
authors: A
authors: Paul
authors: Thorsten
authors: T
authors: Feldkamp
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000925:Anticoagulants / Q000627:therapeutic use*; D002951:Citrates / Q000627:therapeutic use*; D058625:End Stage Liver Disease / Q000150:complications* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D017582:Renal Replacement Therapy; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D002951:Citrates