INCEPTION: is a larger trial to evaluate intraoperative renal replacement therapy in liver transplant patients more than just a dream?

Excerpt

The perioperative management of liver transplant (LT) patients is complicated by multiple factors. Liver transplant patients are frequently hemodynamically unstable with metabolic derangements, coagulopathy, and multiorgan failure, including acute kidney injury (AKI).1-3 The surgery itself may exacerbate these issues with significant bleeding, graft reperfusion, and large volume intravenous fluid infusion leading to rapid changes in acid-base status (e.g., acidosis), serum electrolyte concentrations (e.g., hyperkalemia and hyponatremia), and hypotonicity. The associated hemodynamic instability and brain edema (with increased intracranial pressure) can result in complications such as arrhythmia, central pontine myelinolysis, brain stem herniation, and graft failure—not the intended end result of a surgery meant to restore organ function.4,5 …