Renal replacement therapy and orthotopic liver transplantation: the role of continuous veno-venous hemodialysis.

摘要: Background. The need for renal replacement therapy (RRT) either before or after orthotopic liver transplant (OLTX) has been reported to be a poor prognostic indicator survival. Use of continuous veno-venous hemodialysis (CVVHD) RRT in three series OLTX patients with high 90-day mortality rates 57-60%. We have examined our patient population determine the effect necessity and type on survival OLTX. Methods. analyzed 1535 that were performed at institution from 1985 through 1999, 1037 1995 (period I) 498 1996 1999 II). Combined liver-kidney transplants excluded analysis. Hospital dialysis unit records prospectively maintained database all served as source data. Patients classified into groups defined whether not they received RRT, when RRT. Groups compared preoperative intensive care status, time waiting list, laboratory variables, postoperative mortality, 1-year survival, absolute Results. increased 8.29% period I 12.45% II, along median times. In I, receiving had (0%) (89.5%) almost identical those who never required (1.7% 90.6%). developed acute failure postoperatively requiring however, 28.6% 55%. 39.7% actuarial 54.5% 6.9% 88.6% treated CVVHD 42% 25% alone. However, both pre- 27.7% vs. 50% only postoperatively. postoperatively, which regardless therapy, 41.0% 73.6% started preoperatively, P=0.03. Conclusions. patients. developing an lower highest being present CVVHD, was These findings may reflect trend toward sicker awaiting emphasize negative impact