Intraoperative Single-Pass Batch Sustained Low Efficiency Dialysis (SLED) in Orthotopic Liver Transplantation (OLT).

Abstract

Pts undergoing OLT have often multiorgan dysfunction with severe water, electrolyte and acid-base disorders. These can be further exacerbated by the surgery, which usually necessitates massive blood products and fluid transfusions, and carries a high risk of severe acidosis, hyperkalemia and overhydration. This provides a rationale for an institution of intraoperative renal replacement therapy (ioRRT). The continuous convective RRT has been successfully utilized in these cases, however it requires constant anticoagulation. SLED - the alternate technique, seems to be equal in maintaining hemodynamic stability, while saving nursing time spent for RRT, costs, and enabling heparin-free dialysis. This is a first study examining the usefulness and safety of the single-batch Genius System in ioRRT during OLT. In 2012-1013, 334 pts underwent OLT in our university liver center. In 18 of them (aged 44±14 years, MELD 29.9±10.7), ioSLED-Genius was performed (mean dialysis time 440±152 min), without any anticoagulation. In 13 cases the surgery was urgent (5 retransplantations). The indications for ioSLED were: acidosis (13 pts), acute kidney injury (6 pts), hyperkalemia (2 pts), overhydration (2 pts); 1 pt had been on chronic dialysis before OLT. Mean serum creatinine was 4.2±3.9 mg/dl, and mean lactic acid 4.2±3.9 mmol/l. The average volume of io transfusions was 7.5±0,7 l + 9.9±2.7 units of RBC + 10.5±4.0 units of FFP. In 13 pts RRT was performed during the whole surgery, and in 5 -instituted before the graft reperfusion. 6 pts required only one dialysis. 3 pts needed also 1-3 preoperative RRT, and 10 pts, 1-17 postoperative procedures. None of them became dialysis dependent. There were 4 in-hospital deaths (after 2-21 days). All the RRTs were hemodynamically well tolerated, no serious complications were observed. Conclusions. SLED using mobile single-pass batch system is a safe, cost-effective option for ioRRT during OLT and due to its simplicity and practicability may become a technique of choice in these pts.