Comparison of outcome in liver transplant patients with renal insufficiency and intraoperative CVVH

Background: Intraoperative continuous veno-venous hemofi ltration (CVVH) is an important tool to manage liver transplant (LT) patients with renal insufficiencies. Methods: All LT patients with renal insufficiencies between January 2005 and May 2017 (n=142) were assigned to three groups, those who underwent elective intra-op CVVH (dialysis prior to transplant, necessitating intraoperative CVVH, LTE n=70), unplanned intra-op CVVH (patients who did not require dialysis prior to transplant but were found to have borderline renal insufficiency at the time of LT, LTU n=15) and those with undialysed renal insufficiency (No intraop CVVH or dialysis prior to transplant but had GFR \u3c30 ml/min, LTD n=57). Postoperative complication, graft/patient survival, and long-term renal function were investigated. Results: MELD at transplant was higher in the LTE group (37.5+7.1) compared to the LTU (30.6±10.7) and LTD group (31.7±8.3, P\u3c0.001). Postoperative complication rate (Clavien 3b and above) was similar in all groups, (LTE-45.7%, LTU-46.6% and LTD-26.3%, P=0.06) but LTU patients experienced higher rates of early allograft dysfunction (EAD) (66.6%) compared to the other groups (LTE-30.3% and LTD-25%, P=0.01). Postoperative dialysis requirements was higher in LTE (86.4%) compared to the other groups (66.6% and 10.5%, P\u3c0.001). Duration of dialysis was not significantly different (8, 6 and 29 days, P=0.43). Long-term renal function at 3, 6 and 12 months was similar (P=0.50, P=0.77, P=0.52, respectively). Patient and graft survival was also similar (P=0.51 and P=0.24, respectively). Hospital stay was highest in LTU group (21 days) compared to LTE (16 days) and LTD (13 days, P=0.046). Conclusion: While postoperative complications and graft/patient survival were similar in all three groups, unplanned CVVH may be associated with EAD and longer hospital stay due to acute renal dysfunction at the time of LT. Further investigations are warranted