Acute kidney injury: A critical care perspective for orthotopic liver transplantation.

Andrew J MacDonald, Constantine J Karvellas

Journal: Best practice & research. Clinical anaesthesiology 2021;34(1):69-78

PMID: 32334788

Abstract

Acute kidney injury (AKI) is associated with high perioperative mortality in patients undergoing liver transplantation (LT). In the era of Model of End-stage Liver Disease score-based allocation, more patients with impaired renal function are receiving LT. The majority of preoperative AKI is secondary to azotemia, including hepatorenal syndrome - a progressive form of renal impairment unique to liver failure. Prompt recognition and initiation of cause-directed therapies are central to improving post-transplant survival. Given that, the healthcare providers must develop an expertise in liver failure-related renal complications, specifically their management and perioperative implications. Notably, AKI may complicate intraoperative course, exacerbating hemodynamic instability, metabolic acidosis, and electrolyte and coagulation abnormalities. Adjunctive intraoperative continuous renal replacement therapy has been employed; however, prospective studies remain necessary to validate potential benefits.

Address: Division of General Surgery, University of Alberta, Edmonton, Canada.; Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Canada. Electronic address: [email protected].

DOI: 10.1016/j.bpa.2019.12.002

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https://medlineplus.gov/criticalcare.html

MeSH Terms: Acute Kidney Injury, Critical Care, Humans, Intraoperative Complications, Liver Transplantation