title: [Evaluation of renal function during orthotopic liver transplantation].
abstract: BACKGROUND
  Orthotopic liver transplantation (OLI) is a recognised means of therapy for endstage liver failure (ESLF). Both the preoperative alterations of renal function, closely correlated with the ESLF, and the frequent and abrupt changes of circulating blood volumes occurring during the various phases of OLT are able to significantly alter renal function during the perioperative period.
  
  
  METHODS
  In order to define the specific changes of renal function during the various phases of OLT, six postnecrotic cirrhotic patients undergoing their first OLT entered a prospective study protocol. All the patients had standard and anesthetic techniques including the venovenous bypass (VVBP) during the anhepatic phase. At standard intervals (baseline, during hepatic dissection, during the anhepatic phase, following reperfusion, at the end of surgery) together with complete hemodynamic and metabolic profiles, arterial blood and urine samples were obtained to determine electrolytes and creatinine concentrations, blood levels of atrial natriuretic factor, aldosterone and renin activity. Using standard formulas creatinine clearance (Ccreat) and Na absolute and fractional excretions (FeNa%) were calculated.
  
  
  RESULTS
  Major changes in the hemodynamic profile occurred during the anhepatic phase in spite of the use of the VVBP (reduced cardiac index, reduced pulmonary wedge pressure, increased systemic vascular resistances). Concomitantly a significant decrease in Ccreat (-67%) and in urinary output, was present while aldosterone and renin activity increased. The changes in Ccreat persisted at the end of surgery in spite of the optimal hemodynamic profile. Aldosterone and renin activity returned to values close to baseline at the end of surgery.
  
  
  CONCLUSIONS
  From these data it is possible to conclude that renal function markedly deteriorates during OLT and it has to be considered at increased risk in the immediate postoperative period. The use of VVBP does not seem to prevent the intraoperative renal impairment.
authors.affiliation: II Servizio Anestesia e Rianimazione, Ospedale Niguarda Ca' Granda, Milano.
authors.forename: A
authors.initials: A
authors.lastname: Corti
authors.forename: A
authors.initials: A
authors.lastname: Degasperi
authors.forename: S
authors.initials: S
authors.lastname: Colussi
authors.forename: E
authors.initials: E
authors.lastname: Mazza
authors.forename: O
authors.initials: O
authors.lastname: Amici
authors.forename: A
authors.initials: A
authors.lastname: Cristalli
authors.forename: M
authors.initials: M
authors.lastname: Prosperi
authors.forename: A
authors.initials: A
authors.lastname: Scaiola
authors.forename: S
authors.initials: S
authors.lastname: Vai
authors.forename: P
authors.initials: P
authors.lastname: Notaro
authors.forename: F
authors.initials: F
authors.lastname: Ceresa
authors.forename: E
authors.initials: E
authors.lastname: Roselli
authors.forename: A
authors.initials: A
authors.lastname: Settembre
authors.forename: E
authors.initials: E
authors.lastname: Santandrea
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012079:Renal Circulation / Q000502:physiology
vernacular_title: Valutazione della funzione renale in corso di trapianto ortotopico di fegato.