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Intravenous fenoldopam for early acute kidney injury after liver transplantation

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Abstract

Purpose

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.

Conclusion

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.

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Author information

Authors and Affiliations

  1. Liver Transplant Anaesthesia and Critical Care, P. Kaisserli ICU, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy

    Gianni Biancofiore, Maria L. Bindi, Massimo Bisà, Massimo Esposito, Luca Meacci & Roberto Mozzo

  2. Epidemiology and Biostatistics Unit, Department of Experimental Pathology, University School of Medicine, Pisa, Italy

    Mario Miccoli & Angelo Baggiani

  3. Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza, Turin, Italy

    Elisabetta Cerutti, Bruna Lavezzo & Chiara Stratta

  4. Liver Transplant Unit, University School of Medicine, Pisa, Italy

    Laura Pucci, Giuseppe Penno & Franco Filipponi

Authors
  1. Gianni Biancofiore
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  2. Maria L. Bindi
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  3. Mario Miccoli
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  4. Elisabetta Cerutti
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  5. Bruna Lavezzo
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  6. Laura Pucci
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  7. Massimo Bisà
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  10. Roberto Mozzo
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  11. Chiara Stratta
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  14. Franco Filipponi
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Correspondence to Gianni Biancofiore.

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Biancofiore, G., Bindi, M.L., Miccoli, M. et al. Intravenous fenoldopam for early acute kidney injury after liver transplantation . J Anesth 29, 426–432 (2015). https://doi.org/10.1007/s00540-014-1951-2

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  • DOI: https://doi.org/10.1007/s00540-014-1951-2

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