The Clinical Application Of Continuous Blood Purification On Liver Transplant Patients With Acute Renal Failure

Objective:To observe the effect of continuous renal replacement therapy (CRRT)on liver transplant patients with acute renal failure (ARF).And to investigate the association between various factors and outcome.Methods:60 liver transplant patients with acute renal failure (ARF) were analyzed retrospectively who stayed in ICU of our hospital from March 2006 to February 2011. and treated with CRRT. For the purpose of the study, all patients were divided into survival group and non-survival group according to the 28-day survivorship. Then, compare the clinical index of such as the vital signs, gas analysis of arterial blood.blood routine, blood biochemistry. APACHE II score, the use of vasoconstrictors and mechanical ventilation and so on in both groups, which were collected before and after treatment of 24h,the end of the CRRT treatment. And also compare some factors between groups before treatment and to do Multivariate analvsis of the risk factor. Results:60 patients were collected,80%were male, and the average age was 50.0±13.6 years old.88.3%were chronic advanced stage hepato-disease,11.7%were acute liver failure. The causes of liver failure included 55%of type B hepatitis cirrhosis and 45% of other reasons.18.3%of the patients suffered liver cancer. Complications including 18 (30.00%) patients of pulmonary infection, respiratory failure; 10 (16.67%) of hepatic encephalopathy;2 cases of acute left heart failure;9 cases of alimentary tract hemorrhage.On the basis of the 28-day survivorship, the over mortality was 55.00%. In the survival group,13 patients had a normal serum creatinine (Scr) in 28-day. In both two groups, the serum creatinine (Scr),urea nitrogen (BUN), electrolyte disturbances were decreased significantly after both 24-hour and the end of the CRRT treatment, in the survival group, prothrombin time(PT) was significantly decreased and blood albumin was significantly improved.The significant differences between the survival and non-survival groups were mechanical ventilation, using of vasopression, APACHEII score.the days of CRRT, potassium.Conclusion:Liver transplant patients with ARF had high mortality, CRRT treatment can keep cleaning micromolecule toxinum, such as Scr and BUN, but has less impact to haemodynamics acid-intoxication, also can correct the electrolyte disturbances and CRRT treatment can improve the prognosis of critical ill patients.but the severity of disease still influence the prognosis, so we should search more variables associated with prognosis and manage early.