Steroid Use in Liver Transplantation: None, Perioperative, or Full Course

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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 10−1 methylprednisolone on induction of anaesthesia. Urine was taken for N-acetyl-β-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) μmol.l−1vs88.5 (39.4) μmol.l−1, respectively). Similar changes were seen in postoperative alanine transferase (865 (739) U.l−1vs517 (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%)vs2/17 (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. (Anaesthesia 2006;61:253–259.)

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