Abstract: FR-PO1013
Intraoperative Sustained Low-Efficiency Dialysis During Orthotopic Liver Transplantation May Reduce Post-Reperfusion Hyperkalemic Events
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
- Wickman, Terrance Joseph, Ochsner Health, New Orleans, Louisiana, United States
- Capalbo, Kathryn, Ochsner Health, New Orleans, Louisiana, United States
- Velasco-Gonzalez, Cruz, Ochsner Health, New Orleans, Louisiana, United States
- Palascak, Matthew W., Ochsner Health, New Orleans, Louisiana, United States
- Bohorquez, Humberto, Ochsner Health, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology.
Background
Intraoperative (IntraOp) renal replacement therapy (RRT) is often performed during orthotopic liver transplantation (OLT) in patients deemed at high risk for IntraOp electrolyte, acid-base or volume-related complications. However, there is scarcity of data supporting this practice. We examined the impact of IntraOp RRT on the incidence of IntraOp electrolyte and acid-base disturbances as well as on the volume of IntraOp blood products.
Methods
We accessed our electronic medical record system to perform a retrospective analysis of patients undergoing OLT at Ochsner Medical Center from 2013 to 2020. During that time, our institutional policy has been to administer IntraOp sustained low-efficiency dialysis (SLED) as RRT modality in patients deemed at high risk for IntraOp complications: serum creatinine (sCr) ≥ 1.5 mg/dL, surgical complexity (eg, 2nd OLT), or pulmonary hypertension. We examined the relationship between the provision of IntraOp SLED and the number of hyperkalemic (K > 5.5 mEq/L) or severe acidemic events (pH < 7.25) occurring IntraOp at 0-, 5-, and 15-min. post-reperfusion, and the volume of IntraOp blood products required.
Results
Of 1,471 patients undergoing OLT, we identified 748 with complete data, 270 (36%) of which received IntraOp SLED. Median preoperative sCr were 1.0 (control) and 1.5 (IntraOp SLED) mg/dL. Hyperkalemic events occurred in 11.5% of those who did not receive SLED (control, n = 478) compared to 6.3% of those who received IntraOp SLED (n = 270) [p=0.03, OR 0.53 (0.3, 0.93)], whereas no differences were observed at 0 or 15 min (0% vs 0% and 1.7% vs 0%, respectively). No difference in acidemic events were observed. Additionally, the IntraOp SLED group received significantly more cryoprecipitate, p=0.0001, OR 1.87, (1.46, 2.39)] than control the group, possibly reflecting greater surgical complexity.
Conclusion
Despite greater risk for hyperkalemia by virtue of their preoperative renal impairment and surgical complexity, IntraOp SLED during OLT resulted in reduced incidence of IntraOp hyperkalemia. This observation warrants prospective examination of the benefit of IntraOp RRT for OLT.