title: Intraoperative Continuous Veno-Venous Hemofiltration Facilitates Surgery in Liver Transplant Patients With Acute Renal Failure.
abstract: BACKGROUND
  We have aggressively used continuous veno-venous hemofiltration (CVVH) on high model for end-stage liver disease (MELD) score liver transplant patients with acute kidney injury and hypothesized that the addition of intraoperative CVVH therapy would improve overall outcomes.
  
  
  METHODS
  We performed a retrospective review of all adult, single organ, liver transplant recipients requiring preoperative renal replacement therapy between January 1, 2011 and June 1, 2013. Intraoperative and perioperative records and laboratory values were collected and used to create a database of these patients. Patients were grouped according to whether or not they underwent CVVH at the time of liver transplantation.
  
  
  RESULTS
  Twenty-one patients with new-onset renal failure requiring preoperative renal replacement therapy received a liver transplant alone. Fourteen received intraoperative CVVH and 7 patients did not. The average MELD score was similar between groups (34 for intraoperative CVVH vs 35; P = .8). Preoperative sodium and potassium were higher for the group receiving intraoperative CVVH, but still fell within normal ranges. Preoperative lactate levels were higher in the group that received intraoperative CVVH (4.7 vs 2.0 mmol/L; P = .01). Intraoperative CVVH did not decrease intraoperative transfusion requirements or intensive care unit (ICU) and hospital lengths of stay. Differences in reoperative rates did not reach statistical significance. All patients were weaned off renal replacement therapy. One-year patient survival rate was 86% for intraoperative CVVH versus 71% without.
  
  
  CONCLUSIONS
  The judicious use of intraoperative CVVH therapy may permit patients with increasing severity of illness to achieve outcomes comparable with less ill patients.
authors: Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA. Electronic address: jlamattina@smail.umaryland.edu.
authors: J C
authors: JC
authors: LaMattina
authors: Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: P J
authors: PJ
authors: Kelly
authors: Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: S I
authors: SI
authors: Hanish
authors: Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: S E
authors: SE
authors: Ottmann
authors: Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: J M
authors: JM
authors: Powell
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: W R
authors: WR
authors: Hutson
authors: Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: V
authors: V
authors: Sivaraman
authors: Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: O
authors: O
authors: Udekwu
authors: Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors: R N
authors: RN
authors: Barth
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007430:Intraoperative Care / Q000379:methods*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends