Treatment of severe lactic acidosis during the pre-anhepatic stage of liver transplant surgery with intraoperative hemodialysis

Vitin, Alexander A.; Muczynski, Kimberly A.; Bakthavatsalam, Ramasamy; Martay, Kenneth; Dembo, Gregory; Metzner, Julia

doi:10.1016/j.jclinane.2009.07.013

Cited by 30 publications

(24 citation statements)

References 48 publications

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“…Intraoperative CRRT may have an important modifying or attenuating effect on intraoperative disturbances in metabolic and/or acid-base control and excessive fluid accumulation [25,26]. Our data would suggest less fluctuation in serum sodium and pH for those receiving CRRT.…”

Section: Discussionmentioning

confidence: 85%

“…Despite this logic, there is an absolute paucity of clinical studies that have evaluated the use of intraoperative CRRT during LT. There have been only four case reports describing the successful application of CRRT for intraoperative support during LT [17,18,24,25]. The most recent, by Vitin et al [25], described the use of intraoperative CVVHDF for uncompensated lactic acidosis during the pre-anhepatic phase of LT.…”

Section: Discussionmentioning

confidence: 99%

“…There have been only four case reports describing the successful application of CRRT for intraoperative support during LT [17,18,24,25]. The most recent, by Vitin et al [25], described the use of intraoperative CVVHDF for uncompensated lactic acidosis during the pre-anhepatic phase of LT. Recently, we described the feasibility, safety and clinical course of 41 consecutive adult LT patients who received intraoperative CRRT [19].…”

Section: Discussionmentioning

confidence: 99%

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An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort Study

Parmar

Bigam²,

Meeberg³

et al. 2011

Blood Purif

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Background: Intraoperative continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT). Our objective was to assess intraoperative CRRT for metabolic control, postoperative complications and outcomes. Methods: Retrospective matched cohort study. Cases were LT patients receiving intraoperative CRRT. Controls were matched for demographics and Model for End-Stage Liver Disease (MELD) score. Data were extracted on physiology, course and outcomes. Results: 72 patients were included. Despite effort to match by MELD, cases had higher scores (35.4 vs. 29.9, p = 0.01) compared to controls. Preoperatively, cases received more vasopressors (p = 0.006), and more RRT (94.4 vs. 25.7%, p < 0.0001). There was no difference in complications (p = 0.35) or ICU re-admission rate (p = 0.29). Cases were more likely to require postoperative RRT (p < 0.0001). There was no difference in hospital mortality (p = 0.61). Conclusions: LT patients selected for intraoperative CRRT more commonly have hemodynamic instability and preoperative acute kidney injury requiring RRT. Despite higher illness severity for cases, there were no differences in complications or mortality.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort Study

Parmar

Bigam²,

Meeberg³

et al. 2011

Blood Purif

View full text Add to dashboard Cite

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“…Type A lactate acidosis resulted from mitochondrial dysfunction and arrest of ATP production causes to lactate accumulation. Disorders such as hypotension (cardiac failure, sepsis, hypovolemia) or weakened oxygenation (hemoglobin transfer disorders) may result in type A acidosis (Allen and Holm, 2008;Vitin et al, 2010). In type B, as underutilization of lactate, oxygen delivery is sufficient; however, carbohydrate metabolism or mitochondrial functions are changed.…”

Section: Introductionmentioning

confidence: 99%

“…In type B, as underutilization of lactate, oxygen delivery is sufficient; however, carbohydrate metabolism or mitochondrial functions are changed. Type B is divided into three subdivisions of B1 (decreasing lactate clearance), B2 (drugs/toxins interfere with oxidative phosphorylation) and B3 (mitochondrial defects) (Vitin et al, 2010;Blackshear et al, 1974). Type B lactic acidosis arises in some diseases such as diabetes mellitus, liver failure, sepsis, and neoplasia (Allen and Holm, 2008;Vitin et al, 2010) and in the presence of some drugs such as phenformin.…”

Section: Introductionmentioning

confidence: 99%

Lactic acidosis treatment by nanomole level of spermidine in an animal model

Sedigh-Ardekani

Sahmeddini

Sattarahmady

et al. 2014

Regulatory Toxicology and Pharmacology

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Intraoperative hemodialysis during liver transplantation: A decade of experience

et al. 2014

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Liver transplantation (LT) for patients with renal dysfunction is frequently complicated by major fluid shifts, acidosis, and electrolyte and coagulation abnormalities. Continuous renal replacement therapy (CRRT) has been previously shown to ameliorate these problems. We describe the safety and clinical outcomes of intraoperative hemodialysis (IOHD) during LT for a group of patients with high Model for End-Stage Liver Disease (MELD) scores. We performed a retrospective study at our institution of patients who underwent IOHD from 2002 to 2012. Seven hundred thirty-seven patients underwent transplantation, and 32% received IOHD. The mean calculated MELD score was 37, with 38% having a MELD score 40. Preoperatively, 61% were in the intensive care unit, 19% were mechanically ventilated, 43% required vasopressor support, and 80% were on some form of renal replacement therapy at the time of transplantation, the majority being on CRRT. Patients on average received 35 U of blood products and 4.8 L of crystalloids without significant changes in hemodynamics or electrolytes. The average urine output was 450 ml, and the average amount of fluid removal with dialysis was 1.8 L. The 90-day patient and dialysis-free survival rates were 90% and 99%, respectively. One-year patient survival rates based on the pretransplant renal replacement status and the MELD status were not statistically different. This is the first large study to demonstrate the safety and feasibility of IOHD in a cohort of critically ill patients with high MELD scores undergoing LT with good patient and renal outcomes. Liver Transpl 20:756-764, 2014. V C 2014 AASLD.

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Treatment of severe lactic acidosis during the pre-anhepatic stage of liver transplant surgery with intraoperative hemodialysis

Cited by 30 publications

References 48 publications

An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort Study

An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort Study

Lactic acidosis treatment by nanomole level of spermidine in an animal model

Intraoperative hemodialysis during liver transplantation: A decade of experience

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