Mitigation of Cytokine Storm by Intraoperative Use of Renal Replacement Therapy During Combined Liver-Kidney Transplantation

• Published in: Transplantation proceedings Vol. 42; no. 6; pp. 2353 - 2356
• Main Authors: Fehervari, I, Fazakas, J, Gerlei, Z, Nemes, B, Kobori, L
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.07.2010; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; C-Reactive Protein - metabolism; Emergency and intensive care: renal failure. Dialysis management; End Stage Liver Disease - surgery; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hemofiltration - methods; Hepatectomy; Humans; Intensive care medicine; Interleukin-6 - blood; Intraoperative Care; Intraoperative Complications - physiopathology; Intraoperative Period; Kidney Transplantation; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Renal Insufficiency - surgery; Renal Replacement Therapy; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Tumor Necrosis Factor-alpha - blood; Digestive system; Liver; Use; Cytokine; Intraoperative; Multiorgan transplantation; Homotransplantation; Kidney; Medicine; Extrarenal dialysis; Treatment; Urinary system; Combined surgery; Surgery; Graft; Kidney transplantation; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.05.142

Abstract Background Combined liver-kidney transplantation (CLKT) is a widely used multiorgan transplantation with good graft survival rates. Previous studies have shown beneficial effects of renal replacement therapy in critically ill patients. This observation led us to use intraoperative continuous veno-venous hemofiltration (CVVH) during multiorgan transplantations. Methods We analyzed (CRP) inflammatory response parameters of tumor necrosis factor (TNF)α, interleukin(IL)-6, procalcitonin (PCT) and C-reactive protein (CRP) at various stages of the combined transplantations. Results All patients survived with well-functioning grafts. Mean ± SD follow-up was 32.8 ± 14.2 months. During the whole operation we used intraoperative CVVH starting at the beginning and continuing in the intensive care unit (ICU) afterward (mean ± SD, 11.2 ± 8.4 hours). Intraoperative TNFα, IL-6, CRP, and PCT were measured before surgery, during hepatectomy in the anhepatic phase, before and after liver reperfusion, exactly before kidney reperfusion, after kidney reperfusion, and upon arrival in the ICU. The wash-out of cytokines together with hemodynamic stability gave optimal circumstances for recovery of the transplanted organs. Conclusions CVVH-based therapy offered stable intraoperative parameters, prevention of fluid overload, correction of metabolic disturbances, and wash-out of cytokines, which gave optimal circumstances for recovery of transplanted organs.