Effect of perioperative steroids on renal function after liver transplantation.
Subclinical renal dysfunction is thought to occur as a systemic manifestation of ischaemia-reperfusion injury of other organs. Liver transplantation is associated with major ischaemia-reperfusion injury. Thirty-four patients undergoing elective liver transplantation were randomly allocated to receive either saline or 10 mg.kg(-1) methylprednisolone on induction of anaesthesia. Urine was taken for N-acetyl-beta-D-glucosaminidase, creatinine and other markers of tubular function. Serum chemistry was measured for 7 days. Creatinine concentration increased in the saline group but not in the methylprednisolone group (p < 0.0001), with the greatest difference on the third postoperative day (mean (SD) 164.8 (135.8) mumol.l(-1)vs 88.5 (39.4) mumol.l(-1), respectively). Similar changes were seen in postoperative alanine transferase (865 (739) U.l(-1)vs 517 (608) U.l(-1), respectively; p < 0.0001) on the second postoperative day. Both groups exhibited increases in markers of renal tubular dysfunction and of glomerular permeability. Patients in the saline group sustained more adverse events (8/17 (47%) vs 2/17 (12%); p = 0.02). The data confirm increased proximal tubular lysosomal turnover, consistent with an increased tubular protein load, following liver transplantation, and suggest that methylprednisolone protects against renal and hepatic dysfunction.
Turner
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S
Lecturer, Academic Unit of Anaesthesia, St James's University Hospital, Leeds. LS9 7TF, UK.
Dhamarajah
S
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Bosomworth
M
M
Bellamy
M C
MC
D000118:Acetylglucosaminidase / Q000652:urine; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D015415:Biomarkers; D005938:Glucocorticoids; D003404:Creatinine; D000410:Alanine Transaminase; D000118:Acetylglucosaminidase; D008775:Methylprednisolone