Prevention of renal impairment by continuous infusion of human atrial natriuretic peptide after liver transplantation.
BACKGROUND
Acute renal failure occurring immediately after liver transplantation and requiring hemodialysis is a major problem resulting in a poor prognosis. We investigated the efficacy of human atrial natriuretic peptide, which has potent natriuretic effects and unique protective effects for glomeruli in preventing acute renal failure after liver transplantation.


METHODS
Thirty-seven patients who underwent live donor liver transplantation with model for end-stage liver disease scores greater than 15 were the subjects of the study. Subjects were prospectively randomized into two groups: patients that received synthetic human atrial natriuretic peptide infusion (Group H: n=19) and those that received conventional diuretics, furosemide and potassium canrenoate (Group C: n=18). The peri- and postoperative changes in hemodynamic status and renal function were compared between the two groups.


RESULTS
There were no statistical differences in the changes in hemodynamic status between groups. Hemodialysis was required after liver transplantation in nine patients, two in Group H and seven in Group C (P=0.04). Postoperative creatinine clearance was higher in Group H (P=0.03). Aldosterone level was suppressed in group H (P=0.006).


CONCLUSIONS
Continuous infusion of synthetic human atrial natriuretic peptide might be effective for preventing acute renal failure requiring hemodialysis after liver transplantation.
Akamatsu
Nobuhisa
N
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Sugawara
Yasuhiko
Y
Tamura
Sumihito
S
Kaneko
Junichi
J
Togashi
Junichi
J
Kishi
Yoji
Y
Imamura
Hiroshi
H
Kokudo
Norihiro
N
Makuuchi
Masatoshi
M
D058186:Acute Kidney Injury / Q000517:prevention & control*; D000328:Adult; D000450:Aldosterone / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D006435:Renal Dialysis
D004232:Diuretics; D000450:Aldosterone; D009320:Atrial Natriuretic Factor