Abstract: FR-PO1012
Slow Low-Efficiency Dialysis (SLED) as an Intraoperative Procedure Enabling Liver Transplantation in Patients with Kidney Failure
Session Information
- Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Wantoch-Rekowski, Filip, Uniwersyteckie Centrum Kliniczne Warszawskiego Uniwersytetu Medycznego Klinika Nefrologii Dializoterapii i Chorob Wewnetrznych, Warsaw, Masovian Voivodeship, Poland
- Rymarz, Aleksandra, Uniwersyteckie Centrum Kliniczne Warszawskiego Uniwersytetu Medycznego Klinika Nefrologii Dializoterapii i Chorob Wewnetrznych, Warsaw, Masovian Voivodeship, Poland
- Zebrowski, Pawel, Uniwersyteckie Centrum Kliniczne Warszawskiego Uniwersytetu Medycznego Klinika Nefrologii Dializoterapii i Chorob Wewnetrznych, Warsaw, Masovian Voivodeship, Poland
- Figiel, Wojciech, Medical University of Warsaw, Department of General, Transplantation and Liver Surgery, Warsaw, Poland
- Grat, Michal, Medical University of Warsaw, Department of General, Transplantation and Liver Surgery, Warsaw, Poland
- Malyszko, Jolanta, Uniwersyteckie Centrum Kliniczne Warszawskiego Uniwersytetu Medycznego Klinika Nefrologii Dializoterapii i Chorob Wewnetrznych, Warsaw, Masovian Voivodeship, Poland
Background
Liver transplantation (LTx) is associated with hemodynamic instability, acid-base and electrolytes abnormalities and necessity of infusion of large volume of fluids and blood. As LTx in patients with kidney disfunction can be challenging intraoperative renal replacement therapy (IORRT) may offer support to perform LTx safely.
Methods
We performed the retrospective analysis of IORRT during LTx performed in University Hospital in 2024. All IORRT were conducted using slow low efficiency dialysis (SLED) with Genius single-pass batch dialysis system (Fresenius Medical Care, Germany). Instead of anticoagulation regular flushes of 100-200 mL saline every 30 to 60 minutes were used.
Results
Among 310 patients who received LTx, 45 required intraoperative IORRT (14.5%). Two required IORRT twice, due to the retransplantation performed during the same hospitalization. In 22 patients (46.8%) LTx was a retransplantation procedure.
25 out of 45 patients (55.5%) required renal replacement therapy (RRT) before LTx, whereas 38 (84.4%) required continuation of RRT after LTx. No significant adverse effects associated with IORRT were observed.
Conclusion
SLED is a safe and effective technique of IORRT and may serve as a kidney support during live-saving procedure of LTx.
| Patients’ preoperative characteristic | |
| Age, mean ± SD | 47.5±14.2 |
| Women % | 44.7% |
| MELD, mean ± SD | 33±13 |
| Serum creatinine, mg/dl, mean ± SD | 2.8 ±2 |
| Glomerular filtration rate (GFR) ml/min/1,73m2 | 38,8 ± 31 |
| Serum total bilirubin, mg/dl, mean ± SD | 14.1±13 |
| Lactate, mg/dl, mean ± SD | 6.6 ± 5 |
| Hiponatremia <135 mmol/l, % | 48.9% |
| IORRT data | |
| Number of patients starting IORRT during the first 60 minutes of LTx, N (%) | 30 (63.8%) |
| Number of patients starting IORRT at least 15 minutes before reperfusion, N (%) | 43 (91.5%) |
| Postreperfusion syndrome, N (%) | 10 (21.3%) |
| Duration of IORRT, minutes, median | 345 |
| Blood flow, ml/min, median | 200 |
| Dialysate flow, ml/min, median | 200 |
| Postoperative data | |
| Duration of RRT after LTx, days, mean ± SD | 18.4 ± 20.6 |
| Duration of hospitalization, days (for survivors) | 36.6 ± 22.2 |
| Serum creatinine at hospital discharge, mean ± SD (for survivors) | 1.42 ± 0.91 |
| Glomerular filtration rate (GFR) ml/min/1,73m2 at hospital discharge, mean ± SD | 66,5 ± 30,5 |
| Mortality during first 7 days after LTx, N (%) | 7 (15.6%) |