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Korean J Crit Care Med > Volume 28(4); 2013 > Article
Korean Journal of Critical Care Medicine 2013;28(4): 309-313. doi: https://doi.org/10.4266/kjccm.2013.28.4.309
간-신장 동시 이식 시 술중 수액관리
Intraoperative Fluid Management in Combined Liver-Kidney Transplantation
Jong Hae Kim, Bo Reum Lim, Jin Yong Jung
Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. jychung@cu.ac.kr
A review of the literature regarding combined liver-kidney transplantation (CLKT) does not provide adequate central venous pressure (CVP) values that would allow for unimpaired hepatic venous outflow and early renal allograft diuresis during the procedure. We report a case of fluid management of CLKT based on the limited literature available in a 59-year-old male with liver cirrhosis and end-stage renal disease. During the preanhepatic phase, CVP was maintained at 5 mmHg. Following portal vein clamping, CVP was reduced to below 5 mmHg until venovenous bypass was initiated. From the neohepatic phase to 1 hour before renal allograft reperfusion, CVP was slowly increased to 10 mmHg. Within an hour before renal allograft reperfusion, maximal crystalloid hydration was used to increase CVP to 15 mmHg. The urine output was replaced to maintain CVP at 8 to 10 mmHg until the end of the surgery. The postoperative course was uneventful. In conclusion, fluid management tailored to each phase yielded beneficial results in a patient with CLKT.
Key Words: central venous pressure; kidney transplantation; liver transplantation
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