Manuscript submission to Best Practice & Research: Clinical Anesthesiology Acute Kidney Injury: A Critical Care Perspective for Orthotopic Liver Transplantation

Publication date: Available online 17 December 2019Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Andrew J. MacDonald, Constantine J. KarvellasAbstractAcute kidney injury is associated with high perioperative mortality in patients undergoing liver transplantation. In the era of Model of End-stage Liver Disease score-based allocation, more patients with impaired renal function are receiving liver transplantation. The majority of preoperative acute kidney injury 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 this, healthcare providers must develop an expertise in liver failure-related renal complications, specifically their management and perioperative implications. Notably, acute kidney injury 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.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research