Are there any benefits to the use of renal replacement therapy during liver transplantation: a narrative review

Abstract

Background: Renal dysfunction is a common co-morbidity in patients needing liver transplantation. This may contribute to the intraoperative challenges due to an increased risk of severe electrolyte disturbances, of metabolic acidosis, of fluid overload and perhaps of cerebral edema. It has been suggested that intraoperative continuous renal replacement therapy reduces the incidence of the problems and some centers, therefore, use it intraoperatively.

Methods: Narrative literature review. We searched the Medline and Embase database for literature between 2008 and 2021 using the following search terms: (liver transplantation OR liver transplant) AND (renal replacement therapy OR renal support OR hemodialysis). Results: In total, we obtained 10 publications, of which 9 were retrospective and 1 was a randomized controlled trial.

Conclusions: Studies showed that intraoperative renal replacement therapy is feasible and safe. It may help to maintain electrolyte and acid-base balance and volume homeostasis. It has not been demonstrated that this leads to less perioperative complications or better short- and long-term outcomes regarding patient and graft survival. Unfortunately, most studies are retrospective, without matched control groups. Prospective randomized trials would be useful to identify patients whose outcome can be improved by the possible benefits of intraoperative RRT during liver transplantation.