title: Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients.
abstract: OBJECTIVE
  The perioperative management of patients presenting for simultaneous liver and kidney transplantation (SLKT) is a complex process. We analysed SLKTs performed in our institution to identify preoperative, intraoperative and post-operative challenges encountered in the management.
  
  
  METHODS
  We retrospectively studied the case records of 12 patients who underwent SLKT between 2009 and 2014 and analysed details of pre-operative evaluation and optimisation, intraoperative anaesthetic management and the implications of use of perioperative continuous renal replacement therapy (CRRT) and the post-operative course of these patients.
  
  
  RESULTS
  Of the total 12 cases, 4 were under 16 years of age. The indications for SLKT were primary hyperoxaluria (5), congenital hepatic fibrosis with polycystic kidney disease (2), ethanol-related end-stage liver disease (ESLD) with hepatorenal syndrome type 1 (1). Four patients had ESLD with end-stage renal disease due to other causes. Six recipients received live donor grafts and 6 patients received cadaveric grafts. Seven patients received intraoperative CRRT. Mean duration of surgery was 12.5 h. Cardiac output monitors used were trans-oesophageal echocardiogram (2), pulmonary artery catheter (1) and pulse contour cardiac output monitor (3). There was 1 sepsis-related mortality on 7(th) post-operative day.
  
  
  CONCLUSIONS
  A thorough pre-operative evaluation and optimisation, knowledge and anticipation of potential problems, and meticulous intraoperative fluid management guided by appropriate monitoring and use of CRRT when needed can help in achieving successful outcomes.
authors: Department of Liver Transplant Anaesthesia and Intensive Care, Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Akila
authors: A
authors: Rajakumar
authors: Department of Liver Transplant Anaesthesia and Intensive Care, Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Shiwalika
authors: S
authors: Gupta
authors: Department of Liver Transplant Anaesthesia and Intensive Care, Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Selvakumar
authors: S
authors: Malleeswaran
authors: Department of Hepatology, Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Joy
authors: J
authors: Varghese
authors: Department of Liver Transplant Anaesthesia and Intensive Care, Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Ilankumaran
authors: I
authors: Kaliamoorthy
authors: Department of Hepatobiliary and Liver Transplant Surgery, Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India; Department of Hepatobiliary and Liver Transplant Surgery, Institute of Liver Studies, King's College, London.
authors: Mohamed
authors: M
authors: Rela
keywords: Anaesthesia for combined solid organ transplants; combined liver-kidney transplantation; intraoperative renal replacement therapy; primary hyperoxaluria; simultaneous liver-kidney transplantation