Perioperative CRRT (Continous Renal Replacement Therapy) practices in management of acute liver failure (ALF) patients undergoing Liver transplantation - A survey based study

ALF is a medical emergency associated with high morbidity and mortality, often necessitating urgent liver transplantation. These patients frequently develop complications such as AKI, metabolic acidosis, and cerebral edema. CRRT is used as a supportive measure in this setting to manage fluid overload, correct electrolyte disturbances, and reduce serum ammonia levels, particularly in hemodynamically unstable patients.

Despite widespread use, there is significant variation in the practices of CRRT in perioperative period in ALF patients undergoing liver transplantation. Currently, no standardized national or international guidelines exist to direct clinicians on the appropriate indications, timing, dose, and modality of CRRT during liver transplant surgery.

This proposed survey-based study aims to collect data from liver transplant centers to understand how CRRT is utilized during perioperative period in ALF patients undergoing transplantation. It will focus on common indications, institutional protocols, timing of initiation in preoperative, intraoperative period and timing of discontinuation in postoperative period, dose and type of anticoagulant used in CRRT. By identifying the range of clinical practices, challenges, and perceived outcomes, the study seeks to highlight current trends and areas of variability in patient care.

The results of this study may help build a foundation for evidence-informed clinical protocols, contribute to knowledge sharing across centres, and encourage the development of consensus guidelines.  Importantly, this study is non-interventional in nature-it involves surveying clinicians and doesnot include any direct patient participation or alteration in patient care.