Use of fenoldopam to control renal dysfunction early after liver transplantation.
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.
Biancofiore
Gianni
G
Post-Surgical and Transplantation Intensive Care Unit, Azienda Ospedaliera Pisana, Ospedale di Cisanello, Pisa, Italy. g.biancofiore@med.unipi.it
Della Rocca
Giorgio
G
Bindi
Lucia
L
Romanelli
Anna
A
Esposito
Massimo
M
Meacci
Luca
L
Urbani
Lucio
L
Filipponi
Franco
F
Mosca
Franco
F
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
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