title: Use of fenoldopam to control renal dysfunction early after liver transplantation.
abstract: With the aim of assessing whether fenoldopam can help to preserve renal function after liver transplantation, we randomized 140 consecutive recipients with comparable preoperative renal function to receive fenoldopam 0.1 microg/kg/minute (group F, 46 patients), dopamine 3 microg/kg/minute (group D, 48 patients), or placebo (group P, 46 patients) from the time of anesthesia induction to 96 hours postoperatively. There were no differences between the groups in intraoperative urinary output or furosemide administration (both P =.1). Daily recordings made during the first 4 postoperative days revealed no significant differences in urinary output (P =.1), serum creatinine (P =.5), the incidence of renal insufficiency (P =.7), the need for loop diuretics (P =.9) or vasoactive drugs (P =.8). In comparison with preoperative levels, creatinine clearance at the end of the study in the patients receiving fenoldopam remained substantially unchanged, whereas it decreased by 39 and 12.3%, respectively, in the subjects receiving placebo or dopamine (P <.001); blood cyclosporine A (CsA) levels were similar in the 3 groups (P =.1). Three subjects died in the intensive care unit (1 in each group, P =.9), 2 of them had renal failure. In conclusion, our results confirm the inefficacy of dopamine in preventing or limiting early renal dysfunction after liver transplantation, and suggest that fenoldopam may preserve creatinine clearance by counterbalancing the renal vasoconstrictive effect of CsA, as it has been reported in previous experimental studies.
authors.affiliation: Post-Surgical and Transplantation Intensive Care Unit, Azienda Ospedaliera Pisana, Ospedale di Cisanello, Pisa, Italy. g.biancofiore@med.unipi.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Biancofiore
authors.forename: Giorgio
authors.initials: G
authors.lastname: Della Rocca
authors.forename: Lucia
authors.initials: L
authors.lastname: Bindi
authors.forename: Anna
authors.initials: A
authors.lastname: Romanelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Esposito
authors.forename: Luca
authors.initials: L
authors.lastname: Meacci
authors.forename: Lucio
authors.initials: L
authors.lastname: Urbani
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage / Q000627:therapeutic use*; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000209:etiology* / Q000517:prevention & control; D016031:Liver Transplantation / Q000473:pathology* / Q000502:physiology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011993:Recombinant Fusion Proteins
chemical_list: D000911:Antibodies, Monoclonal; D018491:Dopamine Agonists; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D005665:Furosemide; D016572:Cyclosporine; D000077552:Basiliximab; D003404:Creatinine; D018818:Fenoldopam; D004298:Dopamine; D008775:Methylprednisolone