Intraoperative Continuous Renal Replacement Therapy During Liver Transplantation: A Meta‐Analysis

• Published in: Liver transplantation Vol. 26; no. 8; pp. 1010 - 1018
• Main Authors: Huang, Hui‐Bin, Xu, Yuan, Zhou, Hua, Zhu, Yan, Qin, Jun‐Ping
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2020
• Subjects: Acute Kidney Injury; Bilirubin; Blood transfusion; Clinical trials; Continuous Renal Replacement Therapy; Creatinine; End Stage Liver Disease - surgery; Humans; Kidney transplantation; Liver; Liver diseases; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Meta-analysis; Mortality; Patients; Renal failure; Renal function; Renal Replacement Therapy; Severity of Illness Index; Surgery; Vasoactive agents
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.25773

Continuous renal replacement therapy (CRRT) is frequently used to treat recipients with renal failure before or after liver transplantation (LT), though evidence supporting its use during surgery remains unclear. Therefore, we conducted a quantitative meta‐analysis to evaluate the effect of intraoperative continuous renal replacement therapy (IORRT) in recipients with pretransplant severe renal dysfunction. We searched PubMed, Embase, and the Cochrane database for trials focusing on LT recipients supported with or without IORRT. Outcomes assessed were mortality, preoperative characteristics, intraoperative data, and predefined postoperative outcomes. Seven trials with 1051 recipients were eligible. Preoperatively, the IORRT group recipients had higher Model for End‐Stage Liver Disease scores (weighted mean difference [WMD], 6.19; 95% confidence interval [CI], 2.51‐9.87), Charlson scores (WMD, 0.45; 95% CI, 0.09‐0.80), acute liver failure (odds ratio [OR], 1.82; 95% CI, 1.27‐2.61), serum creatinine (WMD, 71.33 μmol/L; 95% CI, 1.98‐140.69 μmol/L), total bilirubin level (WMD, 5.05 μmol/L; 95% CI, 1.75‐8.35 μmol/L), intensive care unit admission (OR, 3.53; 95% CI, 1.23‐10.13), vasoactive therapy (OR, 3.80; 95% CI, 2.64‐5.46), ventilator care (OR, 2.52; 95% CI, 1.18‐5.35), and renal replacement therapy (RRT) (OR, 29.37; 95% CI, 7.66‐112.54) compared with control patients. IORRT patients also required more intraoperative blood product transfusion and had more post‐LT RRT (OR, 25.67; 95% CI, 4.92‐133.85). However, there were no significant differences in short‐term mortality (OR, 2.12; 95% CI, 0.82‐5.44) between the groups. In addition, worse longterm mortality was seen in the IORRT group. In conclusion, IORRT is feasible and safe and may help sicker recipients tolerate the LT procedure to achieve short‐term clinical outcomes comparable with less ill patients without IORRT. More high‐quality evidence is needed to verify our conclusion in the future.