title: Outcome analysis of continuous intraoperative renal replacement therapy in the highest acuity liver transplant recipients: A single-center experience.
abstract: Orthotopic liver transplantation is the definitive treatment modality for patients with end-stage liver disease. Pre-orthotopic liver transplantation renal dysfunction has a significant negative influence on outcomes post-orthotopic liver transplantation. Intraoperative renal replacement therapy is an adjunctive therapy to address the metabolic challenges during orthotopic liver transplantation in patients with a high acuity of illness. The impact of intraoperative renal replacement therapy on post-orthotopic liver transplantation outcomes, however, is unclear.
  
  
  
  From October of 2012 to April of 2016, 96 adult patients underwent orthotopic liver transplantation for end-stage liver disease. Three groups were identified: (1) Group I: patients with pre-orthotopic liver transplantation renal dysfunction who underwent intraoperative renal replacement therapy, (2) Group II: patients with pre-orthotopic liver transplantation renal dysfunction who did not receive intraoperative renal replacement therapy, and (3) Group III: patients with orthotopic liver transplantation without evidence of pretransplant renal dysfunction.
  
  
  
  At 17.7 months follow-up, there was no difference in survival among the study groups. Physiologic model for end-stage liver disease at the time of orthotopic liver transplantation was significantly higher in both groups with renal dysfunction (I = 43, II = 39) than in Group III (18). Post-orthotopic liver transplantation, 12-month patient survival in Group II was 100%. While the model for end-stage liver disease score at orthotopic liver transplantation was significantly different between Group I and Group III, the 12-month, post-orthotopic liver transplantation patient survival was comparable at 78% vs 88%, respectively.
  
  
  
  Intraoperative renal replacement therapy is a safe adjunctive therapy during liver transplantation of critically ill patients with renal dysfunction. Identifying patients who require intraoperative renal replacement therapy would improve intraoperative and post-liver transplant survival and may facilitate recovery of native kidney function after transplant.
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Motaz
authors.initials: M
authors.lastname: Selim
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Joohyun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kevin
authors.initials: K
authors.lastname: Regner
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kia
authors.initials: K
authors.lastname: Saeian
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Zanowski
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Alicia
authors.initials: A
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Lois A
authors.initials: LA
authors.lastname: Connolly
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Lauer
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Woehlck
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: jhong@mcw.edu.
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency; D017582:Renal Replacement Therapy; D016896:Treatment Outcome