Intraoperative Continuous Renal Replacement Therapy During Liver Transplantation: A Meta-Analysis
- 1 August 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 26 (8), 1010-1018
- https://doi.org/10.1002/lt.25773
Abstract
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 mu mol/L; 95% CI, 1.98-140.69 mu mol/L), total bilirubin level (WMD, 5.05 mu mol/L; 95% CI, 1.75-8.35 mu mol/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 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.This publication has 33 references indexed in Scilit:
- Renal replacement therapy before, during, and after orthotopic liver transplantationAnnals of Transplantation, 2013
- Management of Renal Dysfunction in Patients Receiving a Liver TransplantClinics in Liver Disease, 2011
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort StudyBlood Purification, 2011
- Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analysesEuropean Journal of Epidemiology, 2010
- Measuring inconsistency in meta-analysesBMJ, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantationJournal of Hepatology, 2002
- Combined Veno-Venous Bypass and High Volume Hemofiltration During Orthotopic Liver TransplantationASAIO Journal, 1993
- Hemodynamic and Metabolic Changes in Hepatic TransplantationMayo Clinic Proceedings, 1989