Fluid and Electrolyte Disorders Associated with Orthotopic Liver Transplantation

  • Alan H. Wilkinson
  • Gabriel M. Danovitch
  • Mathew Mischel
Part of the International Yearbooks of Nephrology book series (IYNE, volume 2)

Abstract

Following the NIH Consensus Development Conference on Liver Transplantation (1) in 1984 there has been a rapid increase in the use of transplantation to treat end stage liver disease (2). As a result it has become apparent that a more aggressive approach has to be taken towards the medical management of patients who would previously have been considered terminally ill (3, 4). In addition the operative and postoperative periods are characterised by unique fluid and electrolyte problems (5–11). A number of studies (12–18) have shown that pre-existing renal dysfunction has a significant impact on the post-operative prognosis, and that the need for hemodialysis following transplantation is associated with increased mortality. The various phases of the operation itself and the massive blood transfusions produce calcium and acid-base disorders which necessitate careful intra- and post-operative monitoring.

Keywords

Cholesterol Magnesium Depression Dopamine Citrate 

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References

  1. 1.
    National Institutes of Health Consensus Development Conference on Liver Transplantation. Hepatology, 4(S1): 1S–110S, 1984.CrossRefGoogle Scholar
  2. 2.
    Busuttil RW, Colonna JO, Hiatt JR, Brems JJ, el Khoury G, Goldstein LI, Quinones WJ, Abdul-Rasool IJ, Ramming KP: The first 100 liver transplants at UCLA. Ann Surg, 206: 387–402, 2987.CrossRefGoogle Scholar
  3. 3.
    O’Grady JG, Williams R: Management of acute liver failure. Schweiz Med Wochenschr, 116: 541–544, 1986.PubMedGoogle Scholar
  4. 4.
    Dindzans VJ, Schade RR, Van Thiel DH: Medical problems before and after transplantation. Gastroenterol Clin North Am, 17: 19–31, 1988.PubMedGoogle Scholar
  5. 5.
    Grenvik A, Gordon R: Postoperative care and problems in liver transplantation. Trans Proc, 19(S4): 17–20, 1987.Google Scholar
  6. 6.
    Moulin D, Paris E, Kalenga M, Francois G, Reynaert M, Tremouroux J, Carlier MA, Veyckemans F, Scholtes JL, Gouverneur JM: Intensive care course after orthotopic liver transplantation in children. Acta Anaesthesiol Belg, 36: 214–221, 1985.PubMedGoogle Scholar
  7. 7.
    Rettke SR, Chantigian RC, Janossy TA, Burritt MF, Van Dyke RA, Harper JV, Ilstrup DM, Taswell HF, Wiesner RH, Krom RAF: Anesthesia approach to hepatic transplantation. Mayo Clin Proc, 64: 224–231, 1989.PubMedGoogle Scholar
  8. 8.
    Rettke SR, Janossy TA, Chantigian RC, Burritt MF, Van Dyke RA, Harper JV, Ilstrup DM, Taswell HF, Wiesner RH, Krom RAF: Hemodynamic and metabolic changes in hepatic transplantation. Mayo Clin Proc, 64: 232–240, 1989.PubMedGoogle Scholar
  9. 9.
    Wu AH, Bracey A, Bryan-Brown CW, Harper JV, Burritt MF: Ionized calcium monitoring during liver transplantation. Arch Pathol Lab Med, 111: 935–938, 1987.PubMedGoogle Scholar
  10. 10.
    Wood RP, Ellis D, Starzl TE: The reversal of the hepatorenal syndrome in four pediatric patients following successful orthotopic liver transplantation. Ann Surg, 205: 415–419, 1987.PubMedCrossRefGoogle Scholar
  11. 11.
    Veyckemans F, Carlier M, Scholtes JL, Gouverneur JM, Decocq L, Gribomont BF, Otte JB, Kestens PJ, de Hemptinne B, Reynaert M: Anesthetic experience in adult and pediatric liver transplantation. Acta Anaesthesiol Belg, 37: 77–87, 1986.PubMedGoogle Scholar
  12. 12.
    Brems JJ, Hiatt JR, Colonna JO, el Khoury G, Quinones WJ, Ramming KP, Ziomek S, Busuttil RW: Variables influencing the outcome following orthotopic liver transplantation. Arch Surg, 122: 1109–1111, 1987.PubMedGoogle Scholar
  13. 13.
    Ceurvas-Mons V, Starzl TE, Van Thiel DH: Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation. Hepatology, 6: 922–927, 1986.CrossRefGoogle Scholar
  14. 14.
    Danovitch GM, Wilkinson AH, Colonna JO, Busuttil RW: Determinants of renal failure in patients receiving orthotopic liver transplants. Kidney Int, 31: 195, 1987.Google Scholar
  15. 15.
    Ellis D, Avner ED: Renal failure and dialysis therapy in children with hepatic failure in the perioperative period of orthotopic liver transplantation. Clin Nephrol, 25: 295–303, 1986.PubMedGoogle Scholar
  16. 16.
    Ellis D, Avner ED, Starzl TE: Renal failure in children with hepatic failure undergoing transplantation. J Pediatr, 108: 393–398, 1986.PubMedCrossRefGoogle Scholar
  17. 17.
    Rimola A, Gavaler JS, Schade RR, el Lankany S, Starzl TE, Van Thiel DH: Effects of renal impairment on liver transplantation. Gastroenterology, 93: 148–156, 1987.PubMedGoogle Scholar
  18. 18.
    Stock PG, Belani K, Estrin J: Prognostic perioperative factors in outcome following liver transplantation. Transplant Proc, 19: 2427–2428, 1987.PubMedGoogle Scholar
  19. 19.
    Gerhardt A, Greenberg A, Reilly JJ, Van Thiel DH: Hypercalcemia. A complication of advanced chronic liver disease. Arch Intern Med, 147: 274–277, 1987.PubMedCrossRefGoogle Scholar
  20. 20.
    Sealey MM: Severe hypercalcemia due to a parathyroid-type hormone-secreting tumour of the liver treated by hepatic transplantation. Anaesthesia, 40: 170–177, 1985.PubMedCrossRefGoogle Scholar
  21. 21.
    Atchison SR, Rettke SR, Fromme GA, Janossy TA, Kunkel SE, Williamson KR, Perkins JD, Rakela J: Plasma glucose concentrations during liver transplantation. Mayo Clin Proc, 64: 241–245, 1989.PubMedGoogle Scholar
  22. 22.
    El Khoury GF, Klandorf H, Brems J, Busuttil RW: Pancreatic hormonal responses to hyperglycemia during orthotopic liver transplantation in man. Transplantation, 47: 891, 1989.PubMedCrossRefGoogle Scholar
  23. 23.
    Fortunato FL, Kang Y, Aggarwal S, Freeman JA, Pinsky MR: Acid-base status during and after orthotopic liver transplantation. Transplant Proc, 19(4S3): 59–60, 1987.PubMedGoogle Scholar
  24. 24.
    Gray TA, Buckley BM, Sealey MM, Smith SC, Tomlin P, McMaster P: Plasma ionized calcium monitoring during liver transplantation. Transplantation, 41: 335–339, 1986.PubMedCrossRefGoogle Scholar
  25. 25.
    Ickx B, Walter S, Farman JV: Ionised calcium levels during liver transplantation. Eur J Anaesthesiol, 4: 421–427, 1987.PubMedGoogle Scholar
  26. 26.
    Marquez J, Martin D, Virji MA, Kang YG, Warty VS, Shaw B, Sassano JJ, Waterman P, Winetr PM, Pinsky MR: Cardiovascular depression secondary to ionic hypocalcemia during hepatic transplantation in humans. Anesthesiol, 65: 457–461, 1986.CrossRefGoogle Scholar
  27. 27.
    Munoz SJ, Nagelberg SB, Green PJ, Angstadt JD, Yang SL, Jarrell BE, Maddrey WC: Ectopic soft tissue calcium deposition following liver transplantation. Hepatology, 8: 476–483, 1988.PubMedCrossRefGoogle Scholar
  28. 28.
    Vogt DP, Lederman RJ, Carey WD, Broughan TA: Neurologic complications of liver transplantation. Transplantation, 45: 1057–1061, 1988.PubMedCrossRefGoogle Scholar
  29. 29.
    de Groen PC, Aksamit AJ, Rakela J, Forbes GS, Krom RAF: Central nervous system toxicity after liver transplantation. New Eng J Med, 317: 861–866, 1987.PubMedCrossRefGoogle Scholar
  30. 30.
    de Groen PC: Cyclosporine, low-density lipoprotein, and cholesterol. Mayo Clin Proc, 63: 1012–1021, 1988.PubMedGoogle Scholar
  31. 31.
    Deierhoi MH, Kalayoglu M, Sollinger HW, Belzer FO: Cyclosporine neurotoxicity in liver transplant recipients. Transplant Proc, 20: 116–118, 1988.PubMedGoogle Scholar
  32. 32.
    Bennet WM, Porter GA: Cyclosporine-associated hypertension. Am J Med, 85: 131–133, 1988.CrossRefGoogle Scholar
  33. 33.
    Shirer HW, Erichsen DF, Orr JA: Cardiorespiratory responses to HCl vs lactic acid infusion. J Appl Physiol, 65: 534–540, 1988.PubMedGoogle Scholar
  34. 34.
    Savino JA, Cerabona T, Agarwal N, Byrne D: Manipulation of ascitic fluid pressure in cirrhotics to optimize hemodynamic and renal function. Ann Surg, 208: 504–511, 1988.PubMedCrossRefGoogle Scholar
  35. 35.
    Poison RJ, Park GR, Lindrop MJ, Farman JV, Calne RY, Williams R: The prevention of renal impairment in patients undergoing orthotopic liver grafting by infusion of low dose dopamine. Anaesthesia, 42: 15–19, 1987.CrossRefGoogle Scholar
  36. 36.
    O’Grady JG, Forbes A, Rolles K, Calne RY, Williams R: An analysis of cyclosporine efficacy and toxicity after liver transplantation. Transplantation, 45: 575–579, 1988.PubMedCrossRefGoogle Scholar
  37. 37.
    Powell-Jackson PR, Young B, Calne RY, Williams R: Nephrotoxicity of parenterally administered cyclosporine after orthotopic liver transplantation. Transplantation, 36: 505–508, 1983.PubMedCrossRefGoogle Scholar
  38. 38.
    Gonwa TA, Poplawski SC, Husberg BS, Nery JR, Klintmalm GB: Cyclosporine nephrotoxicity in orthotopic liver transplantation. Trans Proc, 20(S3): 401–404, 1988.Google Scholar
  39. 39.
    Iwatsuki S, Esquivai CO, Klintmalm GB, Gordon RD, Shaw BW, Starzl TE: Nephrotoxicity of cyclosporine in liver transplantation. Trans Proc, 17(S1): 191–195, 1985.Google Scholar
  40. 40.
    Klintmalm GB, Klingensmith WC, Iwatsuki S, Schroter GP, Starzl TE: 99mTc-DTPA and 1131-Hippuran findings in liver transplant recipients treated with cyclosporine A. Radiology, 142: 199–202, 1982.PubMedGoogle Scholar
  41. 41.
    Grant D, Wall W, Duff J, Stiller C, Ghent C, Keown P: Adverse effects of cyclosporine therapy following liver transplantation. Transplant Proc, 19: 3463–3465, 1987.PubMedGoogle Scholar
  42. 42.
    Neumayer HH, Wagner K: Prevention of delayed graft function in cadaver kidney transplants by diltiazem: outcome of two prospective randomised clinical trials. J Cardiovasc Pharm, 10: S170-S177, 1987.Google Scholar
  43. 43.
    Desai TK, Tsang TK: Aminoglycoside nephrotoxicity in obstructive jaundice. Am J Med, 85: 47–50, 1988.PubMedCrossRefGoogle Scholar
  44. 44.
    Lietman PS: Liver disease, aminoglycoside antibiotics and renal dysfunction. Editorial. Hepatology, 8: 966–968, 1988.PubMedCrossRefGoogle Scholar
  45. 45.
    Sacks PS, Fellner SK: Recurrent reversible acute renal failure from Amphotericin. Arch Intern Med, 147:593–595, 1987.PubMedCrossRefGoogle Scholar
  46. 46.
    Gordon RD, Tzakis AG, Iwatsuki S, Todo S, Esquivel CO, Marsh JW, Stieber A, Molowka L, Starzl TE: Experience with OKT3 monoclonal antibody in liver transplantation. Am J Kidney Dis, 11: 141–144, 1988.PubMedGoogle Scholar
  47. 47.
    Millis JM, McDiarmid SV, Hiatt JR, Brems JJ, Colonna JO, Klein AS, Ashizawa T, Hart J, Lewin K, Goldstein LI, Busuttil RW: Randomised prospective trial of OKT3 for early prophylaxis of rejection after liver transplantation. Transplantation, 47: 82–88, 1989.PubMedCrossRefGoogle Scholar
  48. 48.
    Gonwa TA, Nery JR, Husberg BS, Klintmalm GB: Simultaneous liver and renal transplantation in man. Transplantation, 46: 690–693, 1988.PubMedCrossRefGoogle Scholar
  49. 49.
    McDiarmid SV, Ettenger RB, Senguttvan P, Hawkins R, Busuttil RW, Ament ME: The impairment of the true GFR in pediatric liver transplant recipients. Transplantation, 1989 (in press).Google Scholar
  50. 50.
    McDiarmid SV, Ettenger RB, Fine RN, Busuttil RW, Ament ME: Serial decrease in glomerular filtration rate in long-term pediatric liver transplant survivors treated with cyclosporine. Transplantation, 47: 314–318, 1989.PubMedCrossRefGoogle Scholar
  51. 51.
    Williams R, Blackburn A, Neuberger J, Calne RY: Long-term use of cyclosporine in liver grafting. Q J Med, 224: 897–905, 1985.Google Scholar
  52. 52.
    Iwatsuki S, Starzl TE, Shaw BW, Yank SL, Ziteili BJ, Gartner JC, Malatack JJ: Long term use of cyclosporine in liver recipients. Reduction of dosages in the first year to avoid nephrotoxicity. Transplantation, 36: 641–643, 1983.PubMedCrossRefGoogle Scholar
  53. 53.
    Wilkinson AH, Ross EA, Hawkins RA, Danovitch GM: Measurement of the true GFR in renal transplant patients receiving cyclosporine. Transplant Proc, 19: 1739–1741, 1987.PubMedGoogle Scholar
  54. 54.
    Slomowitz LA, Wilkinson AH, Hawkins RA, Danovitch GM: Evaluation of kidney function in renal transplant patients receiving long-term cyclosporine. Am J Kidney Dis, 1989 (in press).Google Scholar
  55. 55.
    Khoury GF, Kaufman RD, Musich JA, Mogard M: Neurotensin and vasoactive intestinal peptide levels during orthotopic liver transplantation. Anesth Analg, 65: S79-S79, 1986.(Abstract)Google Scholar
  56. 56.
    Tuman KJ, Spiess BD, McCarthy RJ, Logas WG, Williams JW, Sankary HN: Effects of continuous arteriovenous hemofiltration on cardiopulmonary abnormalities during anesthesia for orthotopic liver transplantation. Anesth Analg, 67: 363–369, 1988.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • Alan H. Wilkinson
    • 1
  • Gabriel M. Danovitch
    • 1
  • Mathew Mischel
    • 1
  1. 1.Department of MedicineUCLA School of MedicineLos AngelesUSA

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