Perioperative Renal Replacement Therapy in Liver Transplantation

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Renal dysfunction is a common perioperative complication in patients with end-stage liver disease (ESLD) undergoing liver transplantation (LT), with an estimated prevalence of 30% in pretransplant patients and up to 60% after transplant.1,2 Since the implementation of the model for end-stage liver disease (MELD) for liver allocation in the United States in 2002, a greater number of patients with renal dysfunction are undergoing LT.3 Serum creatinine (SCr) weighs heavily in the MELD score calculation, and, consequently, patients with renal dysfunction receive priority for LT. Whether occurring before or after transplant, renal dysfunction is a significant risk factor for major morbidity and mortality.4–6 Renal replacement therapy (RRT) thus has become essential in the perioperative care of the liver transplant patient. In this chapter, we review the causes of renal dysfunction and the use of RRT before, during, and after LT.
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