Comparison of outcome in liver transplant patients who underwent intraoperative CVVH in elective and unplanned settings

Background: Intraoperative continuous veno-venous hemofiltration (CVVH) is an important tool to manage liver transplantation (LT) patients with renal insufficiencies. Methods: All LT patients who underwent intraoperative CVVH between January 2005 and May 2017 (n=65) were assigned to either an elective (dialysis prior to transplant, necessitating intraoperative CVVH, LTE n=51) or unplanned (No dialysis requirement prior to transplant but found to have borderline renal insufficiency at time of LT, LTU n=14) group and investigated for postoperative complication, graft/patient survival, and long-term renal function. Results: MELD at transplant was higher in the LTE group (37.9±6.5) compared to the LTU group (30.6±10.7, P=0.002). Postoperative complication rate (Clavien 3b and above) was similar in both LTE (45.1%) and LTU (21.4%, P=0.13) but LTU patients experienced higher rates of early allograft dysfunction (EAD) (64.3% Vs 28.6% P=0.03). Postoperative dialysis requirements was higher (86.2% Vs 64.3%, P=0.03) with longer duration (7.5 Vs 2 days, P=0.07) in LTE group compared to LTU group. Long-term renal function at 3, 6 and 12 months was similar in both groups (P=0.57, P=0.40, P=0.70, respectively). Patient and graft survival was also similar (P=0.31, P=0.60, respectively). Hospital stay showed no difference (P=0.97). Conclusion: While neither elective nor unplanned use of intraoperative CVVH led to comparative increase in postoperative complications or decrease in patient or graft survival, unplanned CVVH may be associated with EAD due to acute renal dysfunction at time of LT. Further investigations are warranted