Intraoperative Continuous Veno-Venous Hemofiltration Facilitates Surgery in Liver Transplant Patients with Acute Renal Failure

J. C. Lamattina, P. J. Kelly, S. I. Hanish, Shane Ottmann, J. M. Powell, W. R. Hutson, V. Sivaraman, O. Udekwu, R. N. Barth

Research output: Contribution to journalArticle

Abstract

Introduction 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. Conclusion The judicious use of intraoperative CVVH therapy may permit patients with increasing severity of illness to achieve outcomes comparable with less ill patients.

Original languageEnglish (US)
Pages (from-to)1901-1904
Number of pages4
JournalTransplantation Proceedings
Volume47
Issue number6
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Hemofiltration
Acute Kidney Injury
Transplants
Liver
Renal Replacement Therapy
End Stage Liver Disease
Length of Stay
Liver Transplantation
Renal Insufficiency
Intensive Care Units
Lactic Acid
Potassium
Reference Values
Survival Rate
Sodium
Databases

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Medicine(all)

Cite this

Intraoperative Continuous Veno-Venous Hemofiltration Facilitates Surgery in Liver Transplant Patients with Acute Renal Failure. / Lamattina, J. C.; Kelly, P. J.; Hanish, S. I.; Ottmann, Shane; Powell, J. M.; Hutson, W. R.; Sivaraman, V.; Udekwu, O.; Barth, R. N.

In: Transplantation Proceedings, Vol. 47, No. 6, 01.07.2015, p. 1901-1904.

Research output: Contribution to journalArticle

Lamattina, J. C. ; Kelly, P. J. ; Hanish, S. I. ; Ottmann, Shane ; Powell, J. M. ; Hutson, W. R. ; Sivaraman, V. ; Udekwu, O. ; Barth, R. N. / Intraoperative Continuous Veno-Venous Hemofiltration Facilitates Surgery in Liver Transplant Patients with Acute Renal Failure. In: Transplantation Proceedings. 2015 ; Vol. 47, No. 6. pp. 1901-1904.
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AU - Ottmann, Shane

AU - Powell, J. M.

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N2 - Introduction 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. Conclusion The judicious use of intraoperative CVVH therapy may permit patients with increasing severity of illness to achieve outcomes comparable with less ill patients.

AB - Introduction 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. Conclusion The judicious use of intraoperative CVVH therapy may permit patients with increasing severity of illness to achieve outcomes comparable with less ill patients.

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