title: Intravenous fenoldopam for early acute kidney injury after liver transplantation.
abstract: OBJECTIVE
  Acute kidney injury remains a serious complication after orthotopic liver transplantation. To date, several 'renal-protective' agents have been explored in this setting but with conflicting and disappointing results. Therefore, our aim is to evaluate the effects of fenoldopam in liver transplant patients with an established renal injury.
  
  
  METHODS
  In this prospective study, intravenous fenoldopam 0.1 µg/kg/min was administered to consecutive liver transplant patients with postoperative (within 7 days from surgery) stage 2 acute kidney injury (AKI) according to the Acute Kidney Injury Network classification. Actual glomerular filtration rate (GFR; calculated by the iohexol plasma clearance), serum creatinine (SCr) and cystatin C (SCyC) were used to assess the effect of the medication on the patients.
  
  
  RESULTS
  During the study, 295 patients underwent liver transplant. Fifty-one patients (17.6%) met the inclusion criteria and the data from 48 patients were analysed. SCr and SCyC levels decreased (p < 0.001 after 48 h; p < 0.0001 after 72 h) and GFR increased (p < 0.001 after 24 h; p < 0.0001 after 72 h). When compared to a cohort of comparable patients with AKI from our historical series, the patients in the present study showed better SCr and SCyC levels. It was not necessary to discontinue the infusion of fenoldopam in any patient because of the occurrence of adverse events potentially attributable to it.
  
  
  CONCLUSIONS
  We showed that fenoldopam was capable of improving some renal function parameters in postoperative liver transplantation patients with on-going AKI. This preliminary study now sets the stage for a multicenter, randomized, placebo-controlled trial in order to provide definite evidence.
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy. g.biancofiore@med.unipi.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Biancofiore
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Bindi
authors.affiliation: Epidemiology and Biostatistics Unit, Department of Experimental Pathology, University School of Medicine, Pisa, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Miccoli
authors.affiliation: Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cerutti
authors.affiliation: Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Bruna
authors.initials: B
authors.lastname: Lavezzo
authors.affiliation: Liver Transplant Unit, University School of Medicine, Pisa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pucci
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bisà
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Esposito
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Meacci
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mozzo
authors.affiliation: Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Stratta
authors.affiliation: Liver Transplant Unit, University School of Medicine, Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Penno
authors.affiliation: Epidemiology and Biostatistics Unit, Department of Experimental Pathology, University School of Medicine, Pisa, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Baggiani
authors.affiliation: Liver Transplant Unit, University School of Medicine, Pisa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000209:etiology; D003404:Creatinine / Q000378:metabolism; D055316:Cystatin C / Q000378:metabolism; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D055316:Cystatin C; D003404:Creatinine; D018818:Fenoldopam