Early Postoperative CRRT After Liver Transplantation in ACLF Patients With Overt HE
Early Postoperative CRRT After Liver Transplantation in ACLF Patients With Overt HE
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.
Inclusion Criteria: Liver transplant recipients who meet all of the following criteria will
 be enrolled

 1. Pre transplant liver failure: Total bilirubin over 171μmol/L and prothrombin activity
 (PTA)<40%;

 2. Overt hepatic encephalopathy(HE): Grade II or higher HE according West Haven
 classification;

 3. HE associated with acute liver failure (Type A) or cirrhosis complicated with portal
 hypertension and/or portal systemic shunts (Type C)

 Exclusion Criteria:

 1. Patients with a previous history of kidney-related diseases and glomerular filtration
 rate <30 millilitre per minute;

 2. Patients with acute renal failure need CRRT before transplantation;

 3. Patients newly developed acute renal failure need CRRT at the time of randomization;

 4. Retransplantation or multiple-organs transplantation;

 5. Any ischemic or hemorrhagic stroke co-morbidity;

 6. Hemodynamic instability requiring fluid resuscitation or very high dose of
 vasopressors;

 7. Extremely moribund patients with an expected life expectancy of less than 24 hours.