Mitigation of cytokine storm by intraoperative use of renal replacement therapy during combined liver-kidney transplantation

I. Fehervari, J. Fazakas, Z. Gerlei, B. Nemes, L. Kóbori

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Combined liver-kidney transplantation (CLKT) is a widely used multiorgan transplantation with good graft survival rates. Previous studies have shown beneficial effects of renal replacement therapy in critically ill patients. This observation led us to use intraoperative continuous veno-venous hemofiltration (CVVH) during multiorgan transplantations. Methods: We analyzed (CRP) inflammatory response parameters of tumor necrosis factor (TNF)α, interleukin(IL)-6, procalcitonin (PCT) and C-reactive protein (CRP) at various stages of the combined transplantations. Results: All patients survived with well-functioning grafts. Mean ± SD follow-up was 32.8 ± 14.2 months. During the whole operation we used intraoperative CVVH starting at the beginning and continuing in the intensive care unit (ICU) afterward (mean ± SD, 11.2 ± 8.4 hours). Intraoperative TNFα, IL-6, CRP, and PCT were measured before surgery, during hepatectomy in the anhepatic phase, before and after liver reperfusion, exactly before kidney reperfusion, after kidney reperfusion, and upon arrival in the ICU. The wash-out of cytokines together with hemodynamic stability gave optimal circumstances for recovery of the transplanted organs. Conclusions: CVVH-based therapy offered stable intraoperative parameters, prevention of fluid overload, correction of metabolic disturbances, and wash-out of cytokines, which gave optimal circumstances for recovery of transplanted organs.

Original languageEnglish
Pages (from-to)2353-2356
Number of pages4
JournalTransplantation Proceedings
Volume42
Issue number6
DOIs
Publication statusPublished - Jul 2010

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Hemofiltration
Renal Replacement Therapy
Liver Transplantation
C-Reactive Protein
Kidney Transplantation
Reperfusion
Transplantation
Calcitonin
Cytokines
Intensive Care Units
Interleukin-6
Lymphotoxin-beta
Kidney
Hepatectomy
Graft Survival
Critical Illness
Survival Rate
Tumor Necrosis Factor-alpha
Hemodynamics
Transplants

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Mitigation of cytokine storm by intraoperative use of renal replacement therapy during combined liver-kidney transplantation. / Fehervari, I.; Fazakas, J.; Gerlei, Z.; Nemes, B.; Kóbori, L.

In: Transplantation Proceedings, Vol. 42, No. 6, 07.2010, p. 2353-2356.

Research output: Contribution to journalArticle

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abstract = "Background: Combined liver-kidney transplantation (CLKT) is a widely used multiorgan transplantation with good graft survival rates. Previous studies have shown beneficial effects of renal replacement therapy in critically ill patients. This observation led us to use intraoperative continuous veno-venous hemofiltration (CVVH) during multiorgan transplantations. Methods: We analyzed (CRP) inflammatory response parameters of tumor necrosis factor (TNF)α, interleukin(IL)-6, procalcitonin (PCT) and C-reactive protein (CRP) at various stages of the combined transplantations. Results: All patients survived with well-functioning grafts. Mean ± SD follow-up was 32.8 ± 14.2 months. During the whole operation we used intraoperative CVVH starting at the beginning and continuing in the intensive care unit (ICU) afterward (mean ± SD, 11.2 ± 8.4 hours). Intraoperative TNFα, IL-6, CRP, and PCT were measured before surgery, during hepatectomy in the anhepatic phase, before and after liver reperfusion, exactly before kidney reperfusion, after kidney reperfusion, and upon arrival in the ICU. The wash-out of cytokines together with hemodynamic stability gave optimal circumstances for recovery of the transplanted organs. Conclusions: CVVH-based therapy offered stable intraoperative parameters, prevention of fluid overload, correction of metabolic disturbances, and wash-out of cytokines, which gave optimal circumstances for recovery of transplanted organs.",
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AU - Fazakas, J.

AU - Gerlei, Z.

AU - Nemes, B.

AU - Kóbori, L.

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