Volume 11 Issue 5
Sep.  2020
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Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association, Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society. Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure[J]. ORGAN TRANSPLANTATION, 2020, 11(5): 533-542. doi: 10.3969/j.issn.1674-7445.2020.05.001
Citation: Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association, Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society. Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure[J]. ORGAN TRANSPLANTATION, 2020, 11(5): 533-542. doi: 10.3969/j.issn.1674-7445.2020.05.001

Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure

doi: 10.3969/j.issn.1674-7445.2020.05.001
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  • Corresponding author: Yang Yang, Email: yysysu@163.com; Chen Guihua, Email: chgh1955@263.net
  • Received Date: 2020-08-19
    Available Online: 2021-01-19
  • Publish Date: 2020-09-15
  • Acute-on-chronic liver failure (ACLF) is a syndrome of acute liver failure complicated by other organ failure on the basis of chronic liver disease. Liver transplantation is the only effective treatment for ACLF. There is still discussion space on the optimal operation timing of ACLF, how to reduce postoperative infection rate, improvement of nutrition and body function. Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association and Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society organized relevant experts to discuss the perioperative management of ACLF liver transplantation from the operation timing, organ protection, nutritional support, infection prevention and control, rehabilitation exercise and regulation of the internal environment, etc. And the expert consensus was developed for the reference of clinicians.

     

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  • [1]
    PAMECHA V, KUMAR S, BHARATHY KG. Liver transplantation in acute on chronic liver failure: challenges and an algorithm for patient selection and management[J]. Hepatol Int, 2015, 9(4):534-542. DOI: 10.1007/s12072-015-9646-9.
    [2]
    SARIN SK, KUMAR A, ALMEIDA JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL)[J]. Hepatol Int, 2009, 3(1):269-282. DOI: 10.1007/s12072-008-9106-x.
    [3]
    GUSTOT T, FERNANDEZ J, GARCIA E, et al. Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis[J]. Hepatology, 2015, 62(1):243-252. DOI: 10.1002/hep.27849.
    [4]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL): an update[J]. Hepatol Int, 2019, 13(4):353-390. DOI: 10.1007/s12072-019-09946-3.
    [5]
    CHOUDHURY A, JINDAL A, MAIWALL R, et al. Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models[J]. Hepatol Int, 2017, 11(5):461-471. DOI: 10.1007/s12072-017-9816-z.
    [6]
    WANG DW, YIN YM, YAO YM. Advances in the management of acute liver failure[J]. World J Gastroenterol, 2013, 19(41):7069-7077. DOI: 10.3748/wjg.v19.i41.7069.
    [7]
    KODALI S, MCGUIRE BM. Diagnosis and management of hepatic encephalopathy in fulminant hepatic failure[J]. Clin Liver Dis, 2015, 19(3):565-576. DOI: 10.1016/j.cld.2015.04.006.
    [8]
    FARKAS S, HACKL C, SCHLITT HJ. Overview of the indications and contraindications for liver transplantation[J]. Cold Spring Harb Perspect Med, 2014, 4(5):a015602. DOI: 10.1101/cshperspect.a015602.
    [9]
    WEISS E, SANER F, ASRANI SK, et al. When is a critically ill cirrhotic patient too sick to transplant? development of consensus criteria by a multidisciplinary panel of 35 international experts[J]. Transplantation, 2020, DOI: 10.1097/TP.0000000000003364[Epubahead of print].
    [10]
    KROWKA MJ, FALLON MB, KAWUT SM, et al. International Liver Transplant Society Practice Guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension[J]. Transplantation, 2016, 100(7):1440-1452. DOI: 10.1097/TP.0000000000001229.
    [11]
    SUNDARAM V, KOGACHI S, WONG RJ, et al. Effect of the clinical course of acute-on-chronic liver failure prior to liver transplantation on post-transplant survival[J]. J Hepatol, 2020, 72(3):481-488. DOI: 10.1016/j.jhep.2019.10.013.
    [12]
    BENSON AB, BURTON JR JR, AUSTIN GL, et al. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation[J]. Liver Transpl, 2011, 17(2):149-158. DOI: 10.1002/lt.22212.
    [13]
    张四梅, 安睿, 刘琳, 等.围手术期液体治疗对经典原位肝移植术后早期肺部并发症的影响[J].中华外科杂志, 2019, 57(6):440-446. DOI:10.3760/cma.j.issn.0529- 5815.2019.06.009.

    ZHANG SM, AN R, LIU L, et al. The effect of perioperative fluid therapy on early postoperative pulmonary complications after orthotopic liver transplantation[J]. Chin J Surg, 2019, 57(6):440-446. DOI: 10.3760/cma.j.issn.0529-5815.2019.06.009.
    [14]
    CARRIER FM, CHASSÉ M, WANG HT, et al. Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review[J]. Can J Anaesth, 2020, 67(1):109-127. DOI: 10.1007/s12630-019-01480-y.
    [15]
    WALLER EA, ADUEN JF, KRAMER DJ, et al. Safety of percutaneous dilatational tracheostomy with direct bronchoscopic guidance for solid organ allograft recipients[J]. Mayo Clin Proc, 2007, 82(12):1502-1508. DOI: 10.1016/S0025-6196(11)61094-X.
    [16]
    COLLE I, LATERRE PF. Hepatorenal syndrome: the clinical impact of vasoactive therapy[J]. Expert Rev Gastroenterol Hepatol, 2018, 12(2):173-188. DOI: 10.1080/17474124.2018.1417034.
    [17]
    GIFFORD FJ, MORLING JR, FALLOWFIELD JA. Systematic review with Meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1[J]. Aliment Pharmacol Ther, 2017, 45(5):593-603. DOI: 10.1111/apt.13912.
    [18]
    FAYED N, REFAAT EK, YASSEIN TE, et al. Effect of perioperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during living donor liver transplantation[J]. J Crit Care, 2013, 28(5):775-782. DOI: 10.1016/j.jcrc.2013.02.016.
    [19]
    UCHINO S, KELLUM JA, BELLOMO R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study[J]. JAMA, 2005, 294(7):813-818. DOI: 10.1001/jama.294.7.813.
    [20]
    DOUTHITT L, BEZINOVER D, UEMURA T, et al. Perioperative use of continuous renal replacement therapy for orthotopic liver transplantation[J]. Transplant Proc, 2012, 44(5):1314-1317. DOI: 10.1016/j.transproceed.2012.01.142.
    [21]
    KANG W, KUDSK KA. Is there evidence that the gut contributes to mucosal immunity in humans?[J]. JPEN J Parenter Enteral Nutr, 2007, 31(3):246-258. DOI: 10.1177/0148607107031003246.
    [22]
    KUDSK KA. Current aspects of mucosal immunology and its influence by nutrition[J]. Am J Surg, 2002, 183(4):390-398. DOI: 10.1016/s0002-9610(02)00821-8.
    [23]
    JABBAR A, CHANG WK, DRYDEN GW, et al. Gut immunology and the differential response to feeding and starvation[J]. Nutr Clin Pract, 2003, 18(6):461-482. DOI: 10.1177/0115426503018006461.
    [24]
    FUKAZAWA K, YAMADA Y, GOLOGORSKY E, et al. Hemodynamic recovery following postreperfusion syndrome in liver transplantation[J]. J Cardiothorac Vasc Anesth, 2014, 28(4):994-1002. DOI: 10.1053/j.jvca.2014.02.017.
    [25]
    SOLDERA J, CAMAZZOLA F, RODRÍGUEZ S, et al. Dobutamine stress echocardiography, myocardial perfusion scintigraphy, invasive coronary angiography, and post-liver transplantation events: systematic review and Meta-analysis[J]. Clin Transplant, 2018, 32(4):e13222. DOI: 10.1111/ctr.13222.
    [26]
    RACHWAN RJ, KUTKUT I, HATHAWAY TJ, et al. Postoperative atrial fibrillation and flutter in liver transplantation: an important predictor of early and late morbidity and mortality[J]. Liver Transpl, 2020, 26(1):34-44. DOI: 10.1002/lt.25631.
    [27]
    FELTRACCO P, CAGNIN A, CAROLLO C, et al. Neurological disorders in liver transplant candidates: pathophysiology and clinical assessment[J]. Transplant Rev (Orlando), 2017, 31(3):193-206. DOI: 10.1016/j.trre.2017.02.006.
    [28]
    DHIMAN RK, THUMBURU KK, VERMA N, et al. Comparative efficacy of treatment options for minimal hepatic encephalopathy: a systematic review and network Meta-analysis[J]. Clin Gastroenterol Hepatol, 2020, 18(4):800-812. DOI: 10.1016/j.cgh.2019.08.047.
    [29]
    SHARMA BC, SHARMA P, LUNIA MK, et al. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy[J]. Am J Gastroenterol, 2013, 108(9):1458-1463. DOI: 10.1038/ajg.2013.219.
    [30]
    CARDOSO FS, GOTTFRIED M, TUJIOS S, et al. Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure[J]. Hepatology, 2018, 67(2):711-720. DOI: 10.1002/hep.29488.
    [31]
    WARRILLOW S, FISHER C, BELLOMO R. Correction and control of hyperammonemia in acute liver failure: the impact of continuous renal replacement timing, intensity, and duration[J]. Crit Care Med, 2020, 48(2):218-224. DOI: 10.1097/CCM.0000000000004153.
    [32]
    SKROBIK Y, DUPREY MS, HILL NS, et al. Low-dose nocturnal dexmedetomidine prevents icu delirium. a randomized, placebo-controlled trial[J]. Am J Respir Crit Care Med, 2018, 197(9):1147-1156. DOI: 10.1164/rccm.201710-1995OC.
    [33]
    KIM D, SHIN BS, SONG I, et al. Relationship between intraoperative bispectral index and consciousness recovery in patients with hepatic encephalopathy undergoing liver transplant: a retrospective analysis[J]. Transplant Proc, 2019, 51(3):798-804. DOI: 10.1016/j.transproceed.2018.10.031.
    [34]
    HWANG S, LEE SG, PARK JI, et al. Continuous peritransplant assessment of consciousness using bispectral index monitoring for patients with fulminant hepatic failure undergoing urgent liver transplantation[J]. Clin Transplant, 2010, 24(1):91-97. DOI: 10.1111/j.1399-0012.2009.01148.x.
    [35]
    MERLI M, GIUSTO M, GENTILI F, et al. Nutritional status: its influence on the outcome of patients undergoing liver transplantation[J]. Liver Int, 2010, 30(2):208-214. DOI: 10.1111/j.1478-3231.2009.02135.x.
    [36]
    ANTHONY PS. Nutrition screening tools for hospitalized patients[J]. Nutr Clin Pract, 2008, 23(4):373-382. DOI: 10.1177/0884533608321130.
    [37]
    RABITO EI, MARCADENTI A, DA SILVA FINK J, et al. Nutritional risk screening 2002, short nutritional assessment questionnaire, malnutrition screening tool, and malnutrition universal screening tool are good predictors of nutrition risk in an emergency service[J]. Nutr Clin Pract, 2017, 32(4):526-532. DOI: 10.1177/0884533617692527.
    [38]
    PLAUTH M, CABRÉ E, RIGGIO O, et al. ESPEN guidelines on enteral nutrition: liver disease[J]. Clin Nutr, 2006, 25(2):285-294. DOI: 10.1016/j.clnu.2006.01.018.
    [39]
    JIE B, JIANG ZM, NOLAN MT, et al. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk[J]. Nutrition, 2012, 28(10):1022-1027. DOI:10.1016/j.nut. 2012.01.017.
    [40]
    HEYLAND DK, STEPHENS KE, DAY AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study[J]. Clin Nutr, 2011, 30(2):148-155. DOI: 10.1016/j.clnu.2010.09.011.
    [41]
    ALLINGSTRUP MJ, ESMAILZADEH N, WILKENS KNUDSEN A, et al. Provision of protein and energy in relation to measured requirements in intensive care patients[J]. Clin Nutr, 2012, 31(4):462-468. DOI: 10.1016/j.clnu.2011.12.006.
    [42]
    MCCLAVE SA, TAYLOR BE, MARTINDALE RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr, 2016, 40(2):159-211. DOI: 10.1177/0148607115621863.
    [43]
    KAIDO T, OGAWA K, FUJIMOTO Y, et al. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation[J]. Am J Transplant, 2013, 13(6):1549-1556. DOI: 10.1111/ajt.12221.
    [44]
    CORBEL A, LADRIÈRE M, LE BERRE N, et al. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study[J]. Clin Microbiol Infect, 2020, 26(4):475-484. DOI: 10.1016/j.cmi.2019.07.018.
    [45]
    YU X, WANG R, PENG W, et al. Incidence, distribution and clinical relevance of microbial contamination of preservation solution in deceased kidney transplant recipients: a retrospective cohort study from China[J]. Clin Microbiol Infect, 2019, 25(5):595-600. DOI: 10.1016/j.cmi.2018.12.040.
    [46]
    YE QF, ZHOU W, WAN QQ. Donor-derived infections among Chinese donation after cardiac death liver recipients[J]. World J Gastroenterol, 2017, 23(31):5809-5816. DOI: 10.3748/wjg.v23.i31.5809.
    [47]
    PERENCEVICH EN, FISMAN DN, LIPSITCH M, et al. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units[J]. Clin Infect Dis, 2004, 38(8):1108-1115. DOI: 10.1086/382886.
    [48]
    HUANG SS, RIFAS-SHIMAN SL, POTTINGER JM, et al. Improving the assessment of vancomycin-resistant enterococci by routine screening[J]. J Infect Dis, 2007, 195(3):339-346. DOI: 10.1086/510624.
    [49]
    ZARPELLON MN, VIANA GF, MITSUGUI CS, et al. Epidemiologic surveillance of multidrug-resistant bacteria in a teaching hospital: a 3-year experience[J]. Am J Infect Control, 2018, 46(4):387-392. DOI: 10.1016/j.ajic.2017.10.012.
    [50]
    中华预防医学会医院感染控制分会, 中华医学会感染病学分会, 中国医院协会医院感染管理专业委员会, 等.中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引[J].中华医院感染学杂志, 2019, 29(13):2075-2080. DOI: 10.11816/cn.ni.2019-191088.

    Branch of Nosocomial Infection Control of Chinese Preventive Medical Association, Branch of Infectious Diseases of Chinese Medical Association, Branch of Nosocomial Infection Management Committee of Chinese Hospital Association. Technical guidelines for prevention and control of carbapenem-resistant gram-negative bacilli infection in China[J]. Chin J Nosocomiol, 2019, 29(13):2075-2080. DOI: 10.11816/cn.ni.2019-191088.
    [51]
    中华人民共和国国家卫生健康委员会.医院隔离技术规范WS/T311[S].北京: 中华人民共和国国家卫生健康委员会, 2009.
    [52]
    PRONOVOST P, NEEDHAM D, BERENHOLTZ S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU[J]. N Engl J Med, 2006, 355(26):2725-2732. DOI: 10.1056/NEJMoa061115.
    [53]
    World Health Organization. Guidelines for the prevention and control of carbapenem-resistant enterobacteriaceae, acinetobacter baumannii and pseudomonas aeruginosa in health care facilities[EB/OL].[2017-10-26].https://apps.who.int/iris/bitstream/handle/10665/259462/9789241550178-eng.pdf?sequence=1.
    [54]
    National Healthcare Safety Network. Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection)[EB/OL].[2015-11-16]. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf.
    [55]
    MARSCHALL J, MERMEL LA, FAKIH M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update[J]. Infect Control Hosp Epidemiol, 2014, 35(7):753-771. DOI: 10.1086/676533.
    [56]
    KALIL AC, METERSKY ML, KLOMPAS M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5):e61-e111. DOI: 10.1093/cid/ciw353.
    [57]
    KOLLEF MH, HAMILTON CW, ERNST FR. Economic impact of ventilator-associated pneumonia in a large matched cohort[J]. Infect Control Hosp Epidemiol, 2012, 33(3):250-256. DOI: 10.1086/664049.
    [58]
    MUSCEDERE JG, DAY A, HEYLAND DK. Mortality, attributable mortality, and clinical events as end points for clinical trials of ventilator-associated pneumonia and hospital-acquired pneumonia[J]. Clin Infect Dis, 2010, 51(Suppl 1):S120-S125. DOI: 10.1086/653060.
    [59]
    SAINT S, GREENE MT, KREIN SL, et al. A program to prevent catheter-associated urinary tract infection in acute care[J]. N Engl J Med, 2016, 374(22):2111-2119. DOI: 10.1056/NEJMoa1504906.
    [60]
    LUAN X, TIAN X, ZHANG H, et al. Exercise as a prescription for patients with various diseases[J]. J Sport Health Sci, 2019, 8(5):422-441. DOI: 10.1016/j.jshs.2019.04.002.
    [61]
    AL-JUDAIBI B, ALQALAMI I, SEY M, et al. Exercise training for liver transplant candidates[J]. Transplant Proc, 2019, 51(10):3330-3337. DOI: 10.1016/j.transproceed.2019.08.045.
    [62]
    MORKANE CM, KEARNEY O, BRUCE DA, et al. An outpatient hospital-based exercise training program for patients with cirrhotic liver disease awaiting transplantation: a feasibility trial[J]. Transplantation, 2020, 104(1):97-103. DOI: 10.1097/TP.0000000000002803.
    [63]
    MAFFEI P, WIRAMUS S, BENSOUSSAN L, et al. Intensive early rehabilitation in the intensive care unit for liver transplant recipients: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2017, 98(8):1518-1525. DOI: 10.1016/j.apmr.2017.01.028.
    [64]
    WALDAUF P, JIROUTKOVÁ K, KRAJČOVÁ A, et al. Effects of rehabilitation interventions on clinical outcomes in critically ill patients: systematic review and Meta-analysis of randomized controlled trials[J]. Crit Care Med, 2020, 48(7):1055-1065. DOI: 10.1097/CCM.0000000000004382.
    [65]
    JEONG HW, JUNG KW, KIM SO, et al. Early postoperative weight gain is associated with increased risk of graft failure in living donor liver transplant recipients[J]. Sci Rep, 2019, 9(1):20096. DOI: 10.1038/s41598-019-56543-3.
    [66]
    FELTRACCO P, CAROLLO C, BARBIERI S, et al. Early respiratory complications after liver transplantation[J]. World J Gastroenterol, 2013, 19(48):9271-9281. DOI: 10.3748/wjg.v19.i48.9271.
    [67]
    CRISMALE JF, MELIAMBRO KA, DEMARIA S JR, et al. Prevention of the osmotic demyelination syndrome after liver transplantation: a multidisciplinary perspective[J]. Am J Transplant, 2017, 17(10):2537-2545. DOI: 10.1111/ajt.14317.
    [68]
    NADIM MK, ANNANTHAPANYASUT W, MATSUOKA L, et al. Intraoperative hemodialysis during liver transplantation: a decade of experience[J]. Liver Transpl, 2014, 20(7):756-764. DOI: 10.1002/lt.23867.
    [69]
    KARVELLAS CJ, TAYLOR S, BIGAM D, et al. Intraoperative continuous renal replacement therapy during liver transplantation: a pilot randomized-controlled trial (INCEPTION)[J]. Can J Anaesth, 2019, 66(10):1151-1161. DOI: 10.1007/s12630-019-01454-0.
    [70]
    PARMAR A, BIGAM D, MEEBERG G, et al. An evaluation of intraoperative renal support during liver transplantation: a matched cohort study[J]. Blood Purif, 2011, 32(3):238-248. DOI: 10.1159/000329485.
    [71]
    HUANG HB, XU Y, ZHOU H, et al. Intraoperative continuous renal replacement therapy during liver transplantation: a Meta-analysis[J]. Liver Transpl, 2020, 26(8):1010-1018. DOI: 10.1002/lt.25773.
    [72]
    KOŚCIELSKA M, MATUSZKIEWICZ-ROWIŃSKA J, ZIENIEWICZ K, et al. Intraoperative dialysis during liver transplantation[J]. Transplant Proc, 2020, DOI: 10.1016/j.transproceed.2020.01.129[Epubahead of print].
    [73]
    吕海金, 刘剑戎, 安玉玲, 等.重型肝炎肝移植术后早期持续性血液滤过的治疗价值[J].中华器官移植杂志, 2015, 36(9):526-530. DOI: 10.3760/cma.j.issn.0254-1785.2015.09.005.

    LYU HJ, LIU JR, AN YL, et al. Continuous veno-venous hemofiltration in fulminant liver failure in early post-transplant period[J]. Chin J Organ Transplant, 2015, 36(9):526-530. DOI: 10.3760/cma.j.issn.0254-1785.2015.09.005.
    [74]
    KIM WH, LEE HJ, YOON HC, et al. Intraoperative oxygen delivery and acute kidney injury after liver transplantation[J]. J Clin Med, 2020, 9(2):564. DOI: 10.3390/jcm9020564.
    [75]
    ZHANG L, CHEN D, TANG X, et al. Timing of initiation of renal replacement therapy in acute kidney injury: an updated Meta-analysis of randomized controlled trials[J]. Ren Fail, 2020, 42(1):77-88. DOI: 10.1080/0886022X.2019.1705337.
    [76]
    STARRT-AKI Investigators, Canadian Critical Care Trials Group, the Australian and New Zealand Intensive Care Society Clinical Trials Group, et al. Timing of initiation of renal-replacement therapy in acute kidney injury[J]. N Engl J Med, 2020, 383(3):240-251. DOI: 10.1056/NEJMoa2000741.
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