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

• Published in: Journal of clinical anesthesia Vol. 22; no. 6; pp. 466 - 472
• Main Authors: Vitin, Alexander, MD, PhD, Muczynski, Kimberly, MD, PhD, Bakthavatsalam, Ramasamy, MD, Martay, Kenneth, MD, Dembo, Gregory, MD, Metzner, Julia, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2010; Elsevier; Elsevier Limited
• Subjects: Acidosis, Lactic - etiology; Acidosis, Lactic - pathology; Acidosis, Lactic - therapy; Acids; Anesthesia; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Catheters; Cytokines; End Stage Liver Disease - therapy; End Stage Liver Disease - virology; Hemochromatosis - complications; Humans; Intraoperative Care - methods; Intraoperative hemodialysis; Ischemia; Lactic acidosis; Liver; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver transplantation: pre-anhepatic stage; Male; Medical sciences; Middle Aged; Molecular weight; Pain Medicine; Postoperative period; Pulmonary arteries; Renal Dialysis - methods; Severity of Illness Index; Surgery; Transplants & implants; Veins & arteries; Intraoperative hemodialysis; Liver transplantation: pre-anhepatic stage; Lactic acidosis; Metabolic disorder; Treatment; Hemodialysis; Surgery; Liver; Anesthesia; Intraoperative; Acid base balance disorder; Acidosis; pre-anhepatic stage; Liver transplantation
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2009.07.013

Abstract Severe uncompensated lactic acidosis manifesting during the pre-anhepatic stage of orthotopic liver transplant surgery is an uncommon event, but it poses serious concern because of the additional lactate production and impaired elimination by the liver that develops during the anhepatic and allograft reperfusion stages of the procedure. A man with end-stage liver disease secondary to hepatitis C and hemochromatosis and normal renal function, who developed severe lactic acidosis in the pre-anhepatic stage of liver transplantation, was treated successfully with intraoperative, continuous venovenous hemodialysis. Hemodialysis effectively corrected the patient's lactic acidosis and removed lactate, which contributed to hemodynamic stability during the anhepatic and graft reperfusion stages of his liver transplant surgery.