Pretransplant hepatoencephalopathy (HE) markedly impacts recipient outcomes after liver transplantation. Intraoperative CRRT showed benefits but feasibility was much concerned. This study aims to observe the effect on consciousness recovery when initiating CRRT early in the post-transplant period in recipients with ACLF and overt HE.
Hepatoencephalopathy (HE) is a common severe decompensation in end stage liver diseases and resulted to the need of liver transplantation (LT). Pretransplant HE markedly impacts recipient outcomes after liver transplantation. HE in acute on chronic liver failure (ACLF) is categorized to type C HE. Hyperammonemia and systemic inflammation have been reported to contribute its development. Continuous renal replacement therapy (CRRT) has been shown great benefits in ACLF patients with HE. Intraoperative CRRT in LT also showed benefits but feasibility was much concerned. Our preliminary retrospective data showed that early CRRT (eCRRT) after LT reduced consciousness recovery time, ventilation days and post-transplant infection rate. This open label, parallel randomized trial will observe the effect on consciousness recovery when initiating CRRT early (eCRRT) in the post-transplant period in recipients with ACLF and overt HE. The CRRT safety and ventilation days, infection, mortality and ICU stay will also be measured.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
250
eCRRT was define as: 1. Initiated within the first 24 post-transplant hours; 2. High volume (35-50ml/kg) hemofiltration; 3. Continuous at least 12 hours per day for 3 days; 4. Standard treatment
Consciousness recovery time
The period from post-transplant immediate to the time when the patient have the first spontaneous eye opening and proper motor response to commands.
Time frame: From the immediate to 30 days after liver transplantation
Adverse events
Any adverse event which probable related with CRRT
Time frame: From the immediate to 7 days after liver transplantation (CRRT therapy period)
Invasive ventilation days
The time period when patients breath with ventilator through artificial airway
Time frame: From the immediate to 30 days after liver transplantation
ICU stay (days)
The time period from transplantation to first ICU discharge
Time frame: up to one year
Reintubation rate
Reintubation after the first extubation following liver transplantation
Time frame: From the immediate to 30 days after liver transplantation
90 days mortality
All cause mortality
Time frame: From the immediate to 90 days after liver transplantation
Infection rate
Any diagnosed infection after transplantation in 30 days
Time frame: From the immediate to 30 days after liver transplantation
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