Requirement for renal replacement therapy following orthotopic liver transplantation in adults is associated with prolonged mechanical ventilation and higher incidence of pneumonia

Introduction

Acute renal failure requiring renal replacement therapy (RRT) is common following orthotopic liver transplantation (OLT) and is associated with increased morbidity and mortality [1]. Prolonged mechanical ventilation in intensive therapy unit (ITU) patients (>3 days) is associated with increases in length of stay, costs, mortality, risk of ventilator-associated pneumonia and sedation requirements [2].

Methods

A retrospective cohort study was conducted on 348 consecutive OLTs in adults performed at the Royal Free Hospital (London, UK) between January 2000 and January 2007. Patients on RRT pretransplant, acute or fulminant hepatic failure, regraft or combined organ transplant were excluded. Primary outcomes were postoperative RRT and renal impairment as defined by the RIFLE criteria. Data also examined included the number of ventilated postoperative days, and the presence of a clinical diagnosis of pneumonia by the ITU physician.

Results

Two hundred and seventy-one patients were included. Thirty-two of them required postoperative RRT. The mean duration of ventilation, prolonged ventilation, length of ITU stay, incidence of pneumonia, and ITU mortality were higher in the RRT group (Table 1).

Table 1

Conclusion

RRT after OLT is associated with prolonged mechanical ventilation, increased risk of pneumonia, and higher ITU mortality.