A 40-year-old male with alcoholic cirrhosis and end-stage renal disease presented for simultaneous liver and kidney transplantation. Hemodialysis was utilized intraoperatively during liver transplantation. During the procedure, the patient developed refractory hypotension and ultimately received hydroxocobalamin for vasoplegia. Shortly after administration, the hemodialysis machine ceased working after a “blood leak” alarm developed. Without the ability to continue intraoperative dialysis, the kidney transplantation portion of his surgery was postponed. The patient was transferred to the intensive care unit, where he underwent continuous renal replacement therapy overnight, and his kidney transplant proceeded the following morning.
CheungpasitpornWHuiJKashaniKBWittwerEDAlbrightRCJrDillonJJ.High-dose hydroxocobalamin for vasoplegic syndrome causing false blood leak alarm. Clin Kidney J. 2017;10:357-362.
2.
WarnerMAMauermannWJArmourSBarbaraDW.Red urinary discolouration following hydroxocobalamin treatment for vasoplegic syndrome. Can J Anesth. 2017;64:673-674.
3.
SutterMTereshchenkoNRafiiRDaubertGP.Hemodialysis complications of hydroxocobalamin: a case report. J Med Toxicol. 2010;6:165-167.
4.
AgopianVGDhillonABaberJ, et al. Liver transplantation in recipients receiving renal replacement therapy: outcomes analysis and the role of intraoperative hemodialysis. Am J Transplant. 2014;14:1638-1647.
5.
StellpflugSJGardnerRLLeroyJMEllsworthHZwankMD.Hydroxocobalamin hinders hemodialysis. Am J Kidney Dis. 2013;62:395.
6.
CamposLParadaBFurrielFCasteloDMoreiraPMotaA.Do intraoperative hemodynamic factors of the recipient influence renal graft function?Transplant Proc. 2012;44:1800-1803.
7.
DesLauriersCABurdaAMWahlM.Hydroxocobalamin as a cyanide antidote. Am J Ther. 2006;13:161-165.
8.
RoderiqueJDVanDyckKHolmanBTangDChuiBSpiessBD.The use of high-dose hydroxocobalamin for vasoplegic syndrome. Ann Thorac Surg. 2014;97:1785-1786.
9.
CaoZGaoYTaoG.Vasoplegic syndrome during liver transplantation. Anesth Analg. 2009;108:1941-1943.
10.
UhlWNoltingAGolorGRostKLKovarA.Safety of hydroxocobalamin in healthy volunteers in a randomized, placebo controlled study. Clin Toxicol (Phila). 2006;44(suppl 1):17-28.
11.
AbdelmalekJThorntonSNizarJSchneirASanchezAP.Successful use of continuous renal replacement therapy after hydroxocobalamin administration. Dial Transplant. 2011;40:415-417.
12.
LimKHeherESteeleD, et al. Hemodialysis failure secondary to hydroxocobalamin exposure. Proc (Bayl Univ Med Cent). 2017;30:167-168.
13.
AgopianVGPetrowskyHKaldasFM, et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg. 2013;258:409-421.
14.
SedraAHStrumE.The role of intraoperative hemodialysis in liver transplant patients. Curr Opin Organ Transplant. 2011;16:323-325.
15.
HilmiIHortonCNPlaninsicRM, et al. The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation. Liver Transpl. 2008;14:504-508.
16.
EleidMFHurstRTVargasHERakelaJMulliganDCAppletonCP.Short-term cardiac and noncardiac mortality following liver transplantation. J Transplant. 2010;2010:910165.
17.
BukowickaBAkarRAOlszewskaASmoterPKrawczykM.The occurrence of postreperfusion syndrome in orthotopic liver transplantation and its significance in terms of complications and short-term survival. Ann Transplant. 2011;16:26-30.
18.
El-SherifNTurittoG.Electrolyte disorders and arrhythmogenesis. Cariol J. 2011;18:233-245.
19.
VitinAMuczynskiKBakthavatsalamRMartayKDemboGMetznerJ.Treatment of severe lactic acidosis during the preanhepatic stage of liver transplant surgery with intraoperative hemodialysis. J Clin Anesth. 2010;22:466-472.
20.
XiaVWGhobrialRMDuB, et al. Predictors of hyperkalemia in the prereperfusion, early post-reperfusion, and late post-reperfusion periods during adult liver transplantation. Anesth Analg. 2007;105:780-785.
21.
SchroederRACollinsBHTuttle-NewhallE, et al. Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2004;18:438-441.
