Gianni Biancofiore1, Maria L Bindi2, Mario Miccoli3, Elisabetta Cerutti4, Bruna Lavezzo4, Laura Pucci5, Massimo Bisà2, Massimo Esposito2, Luca Meacci2, Roberto Mozzo2, Chiara Stratta4, Giuseppe Penno5, Angelo Baggiani3, Franco Filipponi5. 1. Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy. g.biancofiore@med.unipi.it. 2. Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy. 3. Epidemiology and Biostatistics Unit, Department of Experimental Pathology, University School of Medicine, Pisa, Italy. 4. Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza, Turin, Italy. 5. Liver Transplant Unit, University School of Medicine, Pisa, Italy.
Abstract
PURPOSE: Acute kidney injury remains a serious complication after orthotopic liver transplantation. To date, several 'renal-protective' agents have been explored in this setting but with conflicting and disappointing results. Therefore, our aim is to evaluate the effects of fenoldopam in liver transplant patients with an established renal injury. METHODS: In this prospective study, intravenous fenoldopam 0.1 µg/kg/min was administered to consecutive liver transplant patients with postoperative (within 7 days from surgery) stage 2 acute kidney injury (AKI) according to the Acute Kidney Injury Network classification. Actual glomerular filtration rate (GFR; calculated by the iohexol plasma clearance), serum creatinine (SCr) and cystatin C (SCyC) were used to assess the effect of the medication on the patients. RESULTS: During the study, 295 patients underwent liver transplant. Fifty-one patients (17.6%) met the inclusion criteria and the data from 48 patients were analysed. SCr and SCyC levels decreased (p < 0.001 after 48 h; p < 0.0001 after 72 h) and GFR increased (p < 0.001 after 24 h; p < 0.0001 after 72 h). When compared to a cohort of comparable patients with AKI from our historical series, the patients in the present study showed better SCr and SCyC levels. It was not necessary to discontinue the infusion of fenoldopam in any patient because of the occurrence of adverse events potentially attributable to it. CONCLUSION: We showed that fenoldopam was capable of improving some renal function parameters in postoperative liver transplantation patients with on-going AKI. This preliminary study now sets the stage for a multicenter, randomized, placebo-controlled trial in order to provide definite evidence.
RCT Entities:
PURPOSE:Acute kidney injury remains a serious complication after orthotopic liver transplantation. To date, several 'renal-protective' agents have been explored in this setting but with conflicting and disappointing results. Therefore, our aim is to evaluate the effects of fenoldopam in liver transplant patients with an established renal injury. METHODS: In this prospective study, intravenous fenoldopam 0.1 µg/kg/min was administered to consecutive liver transplant patients with postoperative (within 7 days from surgery) stage 2 acute kidney injury (AKI) according to the Acute Kidney Injury Network classification. Actual glomerular filtration rate (GFR; calculated by the iohexol plasma clearance), serum creatinine (SCr) and cystatin C (SCyC) were used to assess the effect of the medication on the patients. RESULTS: During the study, 295 patients underwent liver transplant. Fifty-one patients (17.6%) met the inclusion criteria and the data from 48 patients were analysed. SCr and SCyC levels decreased (p < 0.001 after 48 h; p < 0.0001 after 72 h) and GFR increased (p < 0.001 after 24 h; p < 0.0001 after 72 h). When compared to a cohort of comparable patients with AKI from our historical series, the patients in the present study showed better SCr and SCyC levels. It was not necessary to discontinue the infusion of fenoldopam in any patient because of the occurrence of adverse events potentially attributable to it. CONCLUSION: We showed that fenoldopam was capable of improving some renal function parameters in postoperative liver transplantation patients with on-going AKI. This preliminary study now sets the stage for a multicenter, randomized, placebo-controlled trial in order to provide definite evidence.
Authors: V S Mathur; S K Swan; L J Lambrecht; S Anjum; J Fellmann; D McGuire; M Epstein; R R Luther Journal: Crit Care Med Date: 1999-09 Impact factor: 7.598
Authors: G Della Rocca; L Pompei; M G Costa; C Coccia; L Scudeller; P Di Marco; S Monaco; P Pietropaoli Journal: Anesth Analg Date: 2004-12 Impact factor: 5.108
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097