Patterns of severe injury in pediatric car crash victims: Crash Injury Research Engineering Network database

Background/Purpose

Motor vehicle crashes (MVCs) account for 50% of pediatric trauma. Safety improvements are typically tested with child crash dummies using an in vitro model. The Crash Injury Research Engineering Network (CIREN) provides an in vivo validation process. Previous research suggest that children in lateral crashes or front-seat locations have higher Injury Severity Scale scores and lower Glasgow Coma Scale scores than those in frontal-impact crashes. However, specific injury patterns and crash characteristics have not been characterized.

Methods

Data were collected from the CIREN multidisciplinary crash reconstruction network (10 pediatric trauma centers). Injuries were examined with regard to crash direction (frontal/lateral), restraint use, seat location, and change in velocity at impact (ΔV). Injuries were limited to Abbreviated Injury Scale (AIS) scores of 3 or higher and included head, thoracic, abdominal, pelvic, spine, and long bone (orthopedic) injuries. Standard age groupings (0-4, 5-9, 10-14, and 15-18 years) were used. Statistical analyses used Fisher's Exact test and multiple logistic regressions.

Results

Four hundred seventeen MVCs with 2500 injuries were analyzed (males = 219, females = 198). Controlling for ΔV and age, children in lateral-impact crashes (n = 232) were significantly more likely to suffer severe injuries to the head and thorax as compared with children in frontal crashes (n = 185), who were more likely to suffer severe spine and orthopedic injuries. Children in a front-seat (n = 236) vs those in a back-seat (n = 169) position had more injuries to the thoracic (27% vs 17%), abdominal (21% vs 13%), pelvic (11% vs 1%), and orthopedic (28% vs 10%) regions (P < .05 for all). Seat belts were protective for pelvic (5% vs 12% unbelted) and orthopedic (15% vs 40%) injuries (odds ratio = 3, P < .01 for both).

Conclusion

A reproducible pattern of injury is noted for children involved in lateral-impact crashes characterized by head and chest injuries. The Injury Severity Scale scores were higher for children in front-seat positions. Increased lateral-impact safety measures such as mandatory side curtain airbags may decrease morbidity. Furthermore, continued public education for positioning children in the back seat of cars is warranted.     

The impact of splenic artery embolization on the management of splenic trauma: an 8-year review

Background

Splenic artery embolization (SAE) is an adjunct to nonoperative management (NOM) of splenic injuries. We reviewed our experience with SAE to identify its impact on splenic operations.

Methods

Patients admitted with splenic injuries over an 8-year period were identified and the initial method of management noted (simple observation, SAE, or splenic surgery). The first 4 years (period 1) during which SAE was introduced was compared with the latter 4 years (period 2) when it was used frequently.

Results

There were 304 patients in period 1 and 416 in period 2. NOM was initial management in 59.9% in period 1% and 60.1% in period 2 (P = 1.0) and failure rates were 5.3% versus 2.9%, respectively (P = .12). More SAE procedures were performed in period 2—13.7% versus 4.9% (P ≤.001)—and there was a reduction in the proportion of splenic operations—35.2% versus 26.2% (P <.01).

Conclusions

SAE is associated with a reduction in splenic operations, although it did not alter the failure rate of NOM.     

Determination of national pediatric injury prevention priorities using the Injury Prevention Priority Score

Purpose

Previous studies have found that the Injury Prevention Priority Score (IPPS) provides a reliable and valid method to gauge the relative importance of different injury causal mechanisms at individual trauma centers. This study examines its applicability to prioritizing injury mechanisms on a national level and within defined pediatric age groups.

Methods

A total of 47,158 patients (age <17) in the National Pediatric Trauma Registry were grouped into common injury mechanisms based on ICD-9 E-Codes. Patients also were stratified by age group. IPPS was calculated for each mechanism and within each age group.

Results

Falls of all types account for the greatest number of injuries (n = 15,042; 32%), whereas child abuse results in the most severe injuries (mean Injury Severity Score, 13.3) However, the most significant mechanisms of injury, according to IPPS, were motor vehicle crashes followed by pedestrian struck by motor vehicles. Certain age groups had specific injury problems including child abuse in infants and assault and gun injuries in adolescents.

Conclusions

IPPS provides an objective, quantitative method for determining injury prevention priorities based on both frequency and severity at the national level. It also is sensitive to age-related changes in different mechanisms of injury.     

Effects of grade 1 varicocele detected in the pediatric age-group on testicular development

Purpose

A number of reports have indicated the effectiveness of varicocelectomy on large varicoceles in adolescents. We carried out a 5-year follow-up study to examine the effect of grade 1 varicocele on testicular development.

Methods

Of 31 boys with left grade 1 varicocele (mean age, 12.6 years), 10 underwent microsurgical varicocelectomy and 21 were conservatively observed and evaluated for testicular volume and varicocele grade. The control group consisted of 20 healthy age-matched boys without a varicocele. The mean relative left testicular volume was compared with the right testis and the absolute bilateral testicular volumes among the boys in all groups.

Results

Of 21 boys who were observed, 13 (62%) continued to have grade 1 varicocele, 4 (19%) developed grade 2 varicocele, and the other 4 boys (19%) showed spontaneous resolution. Twelve testes (57%) developed in parallel with the right testis, and 1 boy (5%) who experienced spontaneous resolution of the varicocele had catch-up testicular growth, whereas 8 boys (38%) had left testicular growth delay with or without an increasing grade of varicocele. Varicocelectomy, but not observation, improved the previously noted testicular growth delay. Furthermore, right testicular growth delay was also noted during observation.

Conclusions

More than half of the total number of boys with grade 1 varicocele showed normal development, whereas many boys presented with growth delay in both testes. Thus, we still need to define reliable predictors that will permit selection of the best candidates for varicocelectomy.     

Pediatric treadmill injuries: a public health issue

Background

Treadmill injuries in children tend to be severe and are becoming increasingly common. We present an overview of this problem to promote public awareness, education, and to advocate a prevention strategy for this preventable injury.

Methods

Medical records of all children with treadmill-related injuries during a 6-year period (January 2001-November 2006) from 2 tertiary pediatric hospitals were reviewed. Data on patient demographics, injury related data, types of surgical procedure, and outcome of treatment were collected.

Results

Forty-four children with treadmill-related injuries were admitted in a 6-year period (2001-2006). Each year, the incidence increased with 17 (39%) cases occurring in 2006 so far. The median age of injury at the time of incident was 2.8 years (range, 8 months-12 years). There was a higher incidence in males (55%) compared with females (45%). Most of these injuries were to the hand (75%), full-thickness burns (59%), <1% of total burn surface area (TBSA) (73%), and occurred while the treadmill was in use by an adult (34%). Twenty-one (47%) children required skin grafting surgery.

Conclusion

Treadmill-related burn injuries in children are a serious public health issue and warrants considerable attention. Adult supervision is paramount, and prevention strategies should include child safety features in equipment designs.     

Pain on injection of propofol: a comparison of methylene blue and lidocaine

Study Objective

To investigate whether methylene blue, given before injection of propofol, was effective in reducing the frequency and severity of pain associated with propofol injection.

Design

Prospective, randomized, double-blinded clinical study.

Setting

Operating room of a university hospital.

Patients

90 adult, ASA physical status 1 and 2 patients undergoing elective surgery.

Interventions

Patients were randomly allocated to one of three groups of 30 patients each. Group I received 50 mg of methylene blue, Group II received 40 mg of lidocaine, and Group III, the control group, was given normal saline. All drugs were given as a 2.0 mL bolus 45 seconds before propofol administration.

Measurements

Injection pain using vocal responses, facial grimacing, arm withdrawal, tears, and questioning of the patient were noted. A 4-point scale was used for documenting pain.

Main Results

Pain frequency was 90% in the saline group, whereas the frequencies were significantly lower in the lidocaine and methylene blue groups (26.7% and 40%, respectively).

Conclusions

Intravenous pretreatment with methylene blue appears to be effective in reducing the pain during propofol injection.     

Airway management for victims of penetrating trauma: analysis of 50,000 cases

Background

Current recommendations for victims of penetrating trauma include prompt transportation to a trauma center. It remains unclear whether field intubation allows for improvements in mortality rate.

Methods

A retrospective review of the National Trauma Data Bank of adult victims of penetrating trauma was performed. Standard demographic data, method, and location of airway management were examined. Mortality rate was used as the primary outcome measure.

Results

There were 56,094 victims of penetrating trauma identified. A total of 1,925 patients required a prehospital airway. The mortality rate for patients who underwent airway management at the scene was 69.2%, compared with a rate of 35.9% for patients in whom airway management was deferred. The mortality rate for patients undergoing surgical airway management at the scene was only 23.9%.

Conclusions

Victims of penetrating trauma who require any airway management have a high mortality rate. The cause of this difference awaits further prospective investigation.     

Assessment of pain after injury in the pediatric patient: child and parent perceptions

Background/purpose

Pain is an inevitable consequence of injury. Accurate assessment and treatment of a child’s pain after injury is essential. This study sought to describe children’s pain with injury and to elucidate the concordance of parental and self-reported pain in a pediatric traffic-injured population.

Methods

Children (5 to 17 years) admitted for traffic-related injuries and 1 parent were invited to participate in the study. Consented participants were interviewed within 1 month of injury. Participants were asked to rate current and worst pain on 2 validated pediatric pain assessment scales (Bieri Faces Pain Scale and Color Analogue Scale). Demographic, crash, and injury data were abstracted from the medical record.

Results

Data from 276 child-parent dyads show that most children reported clinically significant pain initially after injury. Greater “worst pain” ratings did not correlate with injury severity but were associated with loss of consciousness and extremity fracture. Generally, parent-report of child’s pain was concordant with child self-report.

Conclusions

This study shows the feasibility of pain assessment for pediatric injury using 2 validated scales and the appropriateness of parental report when the child is not able to provide self-report. Because pain was not correlated with injury severity, pain assessment and intervention for all children with traumatic injuries is strongly recommended.     

Injury patterns among obese children involved in motor vehicle collisions

Purpose

The purpose of this study was to compare injury patterns among obese children to their nonobese counterparts involved in motor vehicle collisions.

Methods

A nationwide data collection program containing occupant, collision, and injury details from police-reported tow-away crashes between 1997 and 2006 were used. Risk ratios (RRs) and associated 95% confidence intervals (CIs) were adjusted for age, sex, restraint, seat track position, vehicle curb weight, and total velocity change.

Results

An estimated 9 million children aged 2 to 17 years (20.2% obese) were involved in motor vehicle collisions during the study period. Among 2-to-5-year-olds, obesity increased the risk of severe head (RR, 3.67; 95% CI, 1.03-13.08) and thoracic (2.27; 1.01-5.08) injuries. Among 6-to-9-year-olds, obesity increased risk of thoracic (2.31; 1.08-4.95) and lower extremity (LE) injuries (1.89; 1.03-3.47). Among 10-to-13-year-olds, obesity increased the risk of severe thoracic (1.98; 1.08-3.65) and LE (6.06; 2.23-16.44) injuries. Among 14-to-17-year-olds, obesity increased risk of severe LE injuries (1.44; 1.04-2.00) but decreased risk of abdominal (0.20; 0.07-0.60) and head (0.33; 0.18-0.60) injuries, very similar to the pattern reported in obese adults.

Conclusion

The pattern of obesity-associated injuries changes from a higher risk of head and thoracic injuries among young children to a pattern in late teenagers that is similar to obese adults.     

Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis

Background

Few studies of pediatric cardiac injuries have been conducted in large cohorts. We, therefore, investigated the epidemiology of these injuries in the United States.

Methods

We identified patients with traumatic cardiac injury from the National Trauma Data Bank, using the International Classification of Diseases, Ninth Revision, codes. Demographic data, clinical data, and inhospital outcomes were compared among 5 age groups. A logistic regression model was used to determine adjusted mortality among these groups.

Results

Six hundred twenty-six patients met criteria. Fifty-nine percent sustained cardiac contusion; 36%, laceration. Penetrating injuries proved more severe than blunt, having lower average Glasgow Coma Scale (6.8 vs 8.7) and higher percentage of patients with Glasgow Coma Scale of 8 or lower (68% vs 53%). Associated injuries occurred in 484 (77%), most common being lung injuries (46%), hemopneumothorax (37%), and rib fractures (26%). Eleven percent underwent laparotomy; 9%, thoracotomy; 2%, craniotomy/craniectomy; and 0.2%, sternotomy. Complications occurred in 80 (13%), most common being cardiac arrest (4%). Firearm injuries result in the highest mortality rate (76%), compared with other mechanisms (26%-31%). Crude mortality in different age strata showed significant differences that were lost after adjustment for confounding variables.

Conclusions

The predominant cardiac injury was blunt (65%; 35% sustained penetrating insults), frequently paired with contusion. Pediatric cardiac injury is associated with excessive inhospital mortality (40%), with no age-related difference in adjusted mortality.     

Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children

Purpose

Nonoperative management is standard treatment of blunt liver or spleen injuries. However, there are few reports outlining the natural history and outcomes of severe blunt hepatic and splenic trauma. Therefore, we reviewed our experience with nonoperative management of grade 4 or 5 liver and spleen injuries.

Methods

A retrospective analysis was performed on patients with grade 4 or 5 (high-grade) blunt liver and/or spleen injuries from April 1997 to July 2007 at our children's hospital. Demographics, hospital course data, and follow-up data were analyzed.

Results

There were 74 high-grade injuries in 72 patients. There were 30 high-grade liver and 44 high-grade spleen injuries. Two patients had both a liver and splenic injury. High-grade liver injuries had a significantly longer length of intensive care and hospital stay compared to high-grade spleen injuries. There were also a significantly higher number of transfusions, radiographs, and total charges in the high-grade liver injuries when compared to the high-grade splenic injuries. The only mortality from solid organ injury was a grade 4 liver injury with portal vein disruption. In contrast, there was only one complication from a high-grade splenic injury—a pleural effusion treated with thoracentesis. There were 5 patients with complications from their liver injury requiring 18 therapeutic procedures. Three patients (10%) with liver injury required readmission as follows: one 5 times, one 3 times, and another one time.

Conclusions

Patients with high-grade liver injuries have a longer recovery, more complications, and greater use of resources than in patients with similar injuries to the spleen.     

Survival Before and After Model for End-stage Liver Disease Score Introduction on the Brazilian Liver Transplant Waiting List

Introduction

To examine whether the official adoption of Model for End-Stage Liver Disease (MELD) as a criterion for organ allocation was effective, we studied risk factors for patient deaths and the accuracy of the MELD score to predict mortality.

Methods

Patients on the waiting list for liver transplantation were divided into two periods depending on whether they were on the waiting list before (period 1) or after (period 2) the MELD introduction in Brazil. The Kaplan-Meier method with log-rank tests were used to study patient survivals. Predictive factors were identified using the Cox regression method. A receiver operating characteristic (ROC) curve was used to analyze Child-Turcotte-Pugh (CTP) and MELD accuracy.

Results

We analyzed 295 patients in period 1 and 240 in period 2. The survivals after 3, 6, 9, and 12 months in periods 1 and 2, were 95.6%, 90.5%, 84.9%, and 69.6% vs 95.7%, 92.1%, 85.3%, and 83.3%, respectively (P = NS). Multivariate analysis showed CTP, MELD-Na, and albumin levels, besides spontaneous bacterial peritonitis (SBP), to be independent factors related to survival in period 1. In period 2, CTP, creatinine levels, international normalized ratio, besides spontaneous bacterial peritonitis, were the independent factors. The ROC curve for CTP was 0.676 and for MELD, 0.644 (P = .4) in period 1. In period 2, the ROC curve for CTP was 0.680 and for MELD, 0.718 (P = .4).

Conclusion

Patient survival on the waiting list for liver transplantation did not change at 1 year after the introduction of the MELD.     

Presence of pneumomediastinum after blunt trauma in children: what does it really mean?

Background

Pneumomediastinum after blunt thoracic trauma is often considered a marker of serious aerodigestive injury that leads to invasive testing. However, the efficacy of such testing in otherwise stable children remains unknown. We hypothesize that pneumomediastinum after blunt trauma in clinically stable children is rarely associated with significant underlying injury.

Methods

We reviewed all patients in our pediatric trauma database (1997-2007) for pneumomediastinum after blunt injury. Patients were then subdivided into 2 groups: group I, isolated thoracic and group II, thoracic and additional injuries. Procedures and imaging were recorded, and outcomes were assessed.

Results

Thirty-two children with blunt thoracic trauma were included as follows: group I (n = 14) and group II (n = 18). In all patients, there were 28 diagnostic procedures performed resulting in only 1 positive test—a bronchial tear found on bronchoscopy in association with obvious respiratory distress. Group I was more than twice as likely to undergo invasive procedures as group II (P < .0001), resulting in significantly greater costs (?$13683 ± 2520 vs $5378 ± 1000; P < .002). Patients in group I also received more diagnostic imaging to assess pneumomediastinum (1.89 vs 1.08 studies/patient per day; P < .05). More than 28% of all patients were completely asymptomatic and had pneumomediastinum as their only marker of injury. Strikingly, these patients received more than 46% of the procedures.

Conclusions

Children with pneumomediastinum from blunt trauma often receive invasive and expensive testing with low yield, especially those with isolated thoracic trauma.     

Identifying the best candidate for radical prostatectomy among patients with high-risk prostate cancer

Background

The current role of radical prostatectomy (RP) in patients with high-risk disease remains controversial.

Objective

To identify which high-risk prostate cancer (PCa) patients might have favorable pathologic outcomes when surgically treated.

Design, setting, and participants

We evaluated 1366 patients with high-risk PCa (ie, at least one of the following risk factors: prostate-specific antigen [PSA] >20 ng/ml, cT3, biopsy Gleason 8-10) treated with RP and pelvic lymph node dissection (PLND) at eight European centers between 1987 and 2009. A favorable pathologic outcome was defined as specimen-confined (SC) disease—namely, pT2-pT3a, node negative PCa with negative surgical margins.

Intervention

All patients underwent radical retropubic prostatectomy and PLND.

Measurements

Univariable and multivariable logistic regression models tested the association between predictors and SC disease. A logistic regression coefficient-based nomogram was developed and internally validated using 200 bootstrap resamples. The Kaplan-Meier method was used to depict biochemical recurrence (BCR) and cancer-specific survival (CSS) rates.

Results and limitations

Overall, 505 of 1366 patients (37%) had SC disease at RP. All preoperative variables (ie, age and PSA at surgery, clinical stage, and biopsy Gleason sum) were independent predictors of SC PCa at RP (all p ≤ 0.04). Patients with SC disease had significantly higher 10-yr BCR-free survival and CSS rates than patients without SC disease at RP (66% vs 47% and 98 vs 88%, respectively; all p < 0.001). A nomogram including PSA, age, clinical stage, and biopsy Gleason sum demonstrated 72% accuracy in predicting SC PCa. This study is limited by its retrospective design and by the lack of an external validation of the nomogram.

Conclusions

Roughly 40% of patients with high-risk PCa have SC disease at final pathology. These patients showed excellent long-term outcomes when surgically treated, thus representing the ideal candidates for RP as the primary treatment for PCa. Prediction of such patients is possible using a nomogram based on routinely available clinical parameters.     

Interleukin-4 receptor cytotoxin as therapy for human malignant pleural mesothelioma xenografts

Background

Malignant pleural mesothelioma (MPM) is an uncommon but highly fatal neoplasm for which only limited treatment is available.

Methods

Immunohistochemical analysis was used to determine the expression of interleukin-4 receptors (IL-4R) on mesothelioma cell lines and resected mesothelioma tumors. Radioreceptor binding assays were used to show that these IL-4R were high-affinity receptors. Previously, we had shown that a chimeric protein composed of a circularly permuted IL-4 molecule fused to a truncated form of Pseudomonas exotoxin A, IL-4(38-37)-PE38KDEL, could be used to kill IL-4R-bearing tumor cells in vitro. The toxicity of this molecule to mesothelioma cell lines was tested using a protein synthesis inhibition assay. A human mesothelioma xenograft model was then developed to assess the efficacy of this molecule in vivo.

Results

All MPM cell lines tested were found to express high-affinity cell-surface IL-4R. Immunohistochemical analysis of resected mesothelioma tumor specimens from 13 patients revealed that all tumors expressed moderate-to-high levels of IL-4R. Coculture of malignant mesothelioma cell lines with IL-4(38-37)-PE38KDEL resulted in a dose-dependent inhibition of tumor cell protein synthesis through an interaction with cell-surface IL-4R. In a nude mouse xenograft model of human MPM, intratumoral administration of IL-4(38-37)-PE38KDEL mediated a dose-dependent decrease in tumor volume and a dose-dependent increase in survival.

Conclusions

The chimeric protein, IL-4(38-37)-PE38KDEL, has potent antitumor effects against MPM both in vitro and in vivo.     

Value of computed tomographic angiography in neck and extremity pediatric vascular trauma

Purpose

We sought to define the sensitivity and specificity of computed tomographic angiography (CTA) in pediatric vascular injuries.

Methods

All neck and extremity CTAs performed in pediatric patients at a level 1 trauma center were reviewed from 2001 to 2007.

Results

Overall, 78 patients were identified with an average age of 15.0 ± 4.0 (0-18 years). Males outnumbered females 3.6:1. CTA was performed for 41 penetrating and 37 blunt traumas. Most penetrating injuries were due to missile wounds (71%) or stab wounds (17%). Eleven major vascular injuries resulted from penetrating trauma. For penetrating trauma, CTA was 100% sensitive and 93% specific. CTA for penetrating trauma had a positive predictive value (PPV) of 85% and negative predictive value (NPV) of 100%. Most blunt injuries were due to motor vehicle accidents (57%), followed by pedestrian hit by car (27%). Eight major vascular injuries resulted from blunt trauma. For blunt trauma, CTA was 88% sensitive and 100% specific. CTA for blunt trauma had a PPV of 100% and an NPV of 97%. The accuracy for penetrating and blunt trauma was 95% and 97%, respectively.

Conclusions

CTA is highly sensitive, specific, and accurate for pediatric neck and extremity vascular trauma.     

Should pregnancy be a sole criterion for trauma code activation: a review of the trauma registry

Background

Trauma complicates 5% to 7% of all pregnancies and the majority are noncatastrophic events.

Methods

All pregnant patients in the trauma registry from April 2004 to December 2008 were reviewed retrospectively for trauma code activation criteria: pregnancy as sole criterion versus anatomic/physiologic criteria. The incidence of emergent cesarean sections also was assessed.

Results

There were a total of 85 Level 2 Trauma activations. Fifty-seven of the 85 activations were for pregnancy only. There were 2 cesarean sections in the pregnancy-alone group and 5 cesarean sections in the anatomic/physiologic group. A Fisher exact test was used to compare the groups. The pregnancy-alone group had a significantly lower number of cesarean sections with a P value of .0364.

Conclusions

Patients with pregnancy as the sole criterion for Level 2 activations had minor injuries and a lower incidence of cesarean sections.     

Severe tyre blast injuries during servicing

Background

The destructive potential of the tyre explosions has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. These blasts mainly affect the personnel servicing big vehicle tyres such as trucks and buses. We aimed to review the relevant literature on tyre blast injuries so as to define the mechanism of injury, outcome, and its methods of prevention.

Methods

A search of the English literature on tyre blast injuries was performed through Medline. Different studies were retrieved, analysed and combined together.

Results

A total of 763 patients were studied in the literature. Most of the patients were young aged male mechanics and the explosions usually occur during tyre servicing especially during inflation. Injury is caused by the pressure impact of the explosion or by direct hit of the rim. The head and face are the most commonly affected regions (48%) followed by the upper limbs (20%). About 25% of patients had multi-trauma. The overall mortality is high (19%) and is mainly caused by head injuries.

Conclusion

Inflated large tyres contain a tremendous amount of potential energy. Tyre blast injuries during servicing have a high morbidity and mortality. Preventive occupational methods should be implemented.     

Perioperative use of continuous renal replacement therapy for orthotopic liver transplantation

Purpose

We present a retrospective study describing the perioperative use of continuous renal replacement therapy (CRRT) for orthotopic liver transplantation (OLT).

Materials and Methods

We retrospectively reviewed the clinical course of patients who underwent OLT with the perioperative use of CRRT. The following variables were recorded: Gender, age, indication for transplantation, time when CRRT was initiated, postoperative need for CRRT, and the patient and organ (liver, kidneys) outcome up to 1 year after transplantation.

Results

Among 105 patients who underwent OLT from 2006 to 2010; we used CRRT in 12 cases (11.4%) perioperatively, including 9 (8.3%) patients intraoperatively. Perioperative CRRT was employed for volume, electrolyte, and/or pH management. All patients who underwent CRRT perioperatively were alive at 1 month, 10 (83.3%), at 3 and 6 months and 9 (75%) at 1 year after OLT. Only 1 surviving patient (8.3%) required renal replacement therapy at 1 month after surgery. Renal replacement therapy was not required in any surviving patient up to 12 months posttransplantation.

Conclusion

Perioperative and especially intraoperative use of CRRT therapy can potentially improve the outcomes of patients undergoing OLT.