Intraoperative continuous renal replacement therapy during liver transplantation: a pilot randomized-controlled trial (INCEPTION)

AbstractPurposeTo evaluate the feasibility of intraoperative continuous renal replacement therapy (IoCRRT) during liver transplantation (LT), in terms of recruitment, protocol adherence, and ascertainment of follow-up.MethodsIn this pilot randomized open-label controlled trial in adults receiving LT with a Model for End-Stage Liver Disease (MELD) score ≥ 25 and preoperative acute kidney injury (RIFLE - RISK or higher) and/or estimated glomerular filtration rate
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research

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Ascites is the most common complication of cirrhosis and represents a watershed moment, with patients' median survival falling from>12 years for compensated cirrhosis to approximately 2 years. Treatment aims to reduce sodium intake and increase renal sodium excretion with the aldosterone antagonist spironolactone, starting at 100  mg daily; 60% respond. Renal dysfunction affects as many as 20% of hospitalized patients and is a strong predictor of mortality. Liver transplantation represents the best treatment for hepatorenal syndrome (HRS) yet is rarely available, and a combination of vasoconstrictors and albumin ...
Source: Medicine - Category: Internal Medicine Authors: Tags: Management problems in liver disease Source Type: research
Ascites occurs in up to 70% of patients during the natural history of cirrhosis. Management of uncomplicated ascites includes sodium restriction and diuretic therapy, whereas that for refractory ascites (RA) is regular large-volume paracentesis with transjugular intrahepatic portosystemic shunt being offered in appropriate patients. Renal impairment occurs in up to 50% of patients with RA with type 1 hepatorenal syndrome (HRS) being most severe. Liver transplant remains the definitive treatment of eligible candidates with HRS, whereas combined liver and kidney transplant should be considered in patients requiring dialysis ...
Source: Clinics in Liver Disease - Category: Gastroenterology Authors: Source Type: research
SM Abstract PURPOSE: To evaluate the feasibility of intraoperative continuous renal replacement therapy (IoCRRT) during liver transplantation (LT), in terms of recruitment, protocol adherence, and ascertainment of follow-up. METHODS: In this pilot randomized open-label controlled trial in adults receiving LT with a Model for End-Stage Liver Disease (MELD) score ≥ 25 and preoperative acute kidney injury (RIFLE - RISK or higher) and/or estimated glomerular filtration rate
Source: Canadian Journal of Anaesthesia - Category: Anesthesiology Authors: Tags: Can J Anaesth Source Type: research
Conclusions: While there is a certain overlap between the results of the current study and published transcriptomic profiles of non-transplanted livers with steatosis, we have identified discrete characteristics of the non-alcoholic fatty liver disease in liver grafts potentially utilizable for the establishment of predictive signature. Introduction Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in industrialized countries, its prevalence being estimated at 19–31.3% (1). It encompasses a range of conditions that are thought to arise from fatty liver (simple steatosis) throu...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
Joanna Mikulak1,2, Elena Bruni1,2, Ferdinando Oriolo1,2, Clara Di Vito1 and Domenico Mavilio1,2* 1Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy 2Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy The liver is considered a preferential tissue for NK cells residency. In humans, almost 50% of all intrahepatic lymphocytes are NK cells that are strongly imprinted in a liver-specific manner and show a broad spectrum of cellular heterogeneity. Hepatic NK (he-NK) cells play key roles in tuning liver immune response in b...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Wenwei Zhang1,2†, Jian Ping1,3,4†, Yang Zhou5, Gaofeng Chen3,4 and Lieming Xu1,2,3,4* 1Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China 2Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China 3Shanghai Key Laboratory of Traditional Chinese Medicine, Shanghai, China 4Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Shanghai, China 5Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China Various isoforms of myocyte enhancer factor 2 (MEF2)...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Congenital hepatic fibrosis (CHF) is a rare genetic liver disease (1/20,000 births) characterized by ductal plate malformation during bile duct development and progressive hepatic fibrosis, and is often associated with autosomal recessive polycystic kidney disease.[1] Liver transplantation is necessary for the treatment of progressive CHF patients with a severe phenotype. There are several pathological evidences to indicate that the mechanism of fibrosis in CHF is quite different from liver cirrhosis due to chronic hepatitis: hepatic fibrosis in CHF patients lacks necroinflammatory changes of hepatocytes and the activation...
Source: Journal of Hepatology - Category: Gastroenterology Authors: Source Type: research
Kidney transplantation is the best treatment for patients with end-stage renal disease (ESRD) because of a significant survival benefit conferred compared to patients who remain on haemodialysis.1 Although the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with ESRD has significantly declined over time, it remains at least 4-times higher than in the general population.2,3 Chronic HCV or HBV infection can result in chronic liver disease, cirrhosis, and hepatocellular carcinoma4 –6 and increase the risk of chronic kidney disease (CKD).
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Research Article Source Type: research
Purpose of review Acute kidney injury (AKI) in cirrhosis consists of varying phenotypes, with hepatorenal syndrome (HRS) representing a single entity. Prompt recognition and diagnosis of AKI cause identifies appropriate therapeutic measures. This review provides an overview of AKI definitions, highlights challenges in quantifying renal impairment in cirrhosis, lists novel diagnostic AKI biomarkers, and summarizes transplantation implications. Recent findings Biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18, and liver-type fatty acid-binding protein) may assist in the ide...
Source: Current Opinion in Critical Care - Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Constantine J. Karvellas Source Type: research
Kidney dysfunction is common in patients with advanced cirrhosis1 –3 and a number of studies have shown that impaired kidney function has a negative impact on outcomes.4 As a result, serum creatinine has been incorporated into the model for end-stage liver disease (MELD) score,4 which is a robust tool to predict short-term mortality in patients with cirrhosis. S ince then, the MELD score has been widely adopted in liver transplantation for prioritization in organ allocation. Even though creatinine level has an independent prognostic value, it is an inaccurate marker of renal function in cirrhosis.
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Editorial Source Type: research
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