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Intraoperative Renal Replacement Therapy for Liver Transplantation: Is There Really a Benefit?

Acute kidney injury at the time of liver transplantation( LT) is associated with increased mortality, particularly for those patients who require hemodialysis (Zand). There are several theoretical benefits of intraoperative RRT (IORRT). Dialysis can correct metabolic acidosis and electrolyte abnormalities including hyperkalemia common during liver transplantation, particularly during the anhepatic phase can reduce fluid overload, especially when large amounts of blood product transfusions are administered. Perioperative fluid balance predicts an increase in post-operative pulmonary complications; IORRT may allow patients with low urine output to avoid fluid overload post-LT (Jiang). However, IORRT is invasive requiring placement of an additional large bore central venous catheter, and clotting of the dialysis circuit during IORRT may result in blood loss. It also is a resource and personnel intensive procedure.