ANESTHETIC SUPPORT IN SYNCHRONOUS LIVER AND KIDNEY-TRANSPLANTATION

BACKGROUND/AIMS: We performed a retrospective evaluation of 11 patient s in the final stages of hepatic disease with chronic kidney failure, in whom simultaneous double liver-kidney transplantation was performed . METHODOLOGY: In the immediate pre-, intra- and postoperative periods , we assessed metabolic, hemodynamic and coagulation parameters; bicar bonate, calcium and inotropic drug requirements; the incidences during reperfusion of the graft; the surgical technique employed; the need f or hemodialysis and/or ultrafiltration; and the survival rate of the p atients. RESULTS: Of the 11 cases studied, four patients needed hemodi alysis, while only one patient needed ultrafiltration; three patients required both techniques, and no dialysis or ultrafiltration was perfo rmed in three patients. The following surgical techniques were employe d: Total clamping of the inferior vena cava using an external venoveno us bypass in two cases; total clamping of the inferior vena cava witho ut an external venovenous bypass in three cases; and partial clamping of the inferior vena cava with preservation of the retrohepatic cava i n six cases. The results showed one death in the first postoperative m onth and two deaths in the course of subsequent follow-up. The surviva l rate was 72.7%. CONCLUSIONS: The use of conventional intraoperative hemodialysis and/or ultrafiltration is feasible, useful and achieves g ood results in patients undergoing double Liver-kidney transplantation . Partial clamping of the inferior vena cava at the anhepatic stage ap pears to reduce the need for ultrafiltration. There is no increase in perioperative mortality in patients who underwent liver transplantatio n while conserving their renal function.