POSTOPERATIVE INTRAVENOUS-INFUSION OF ALPROSTADIL (PGE(1)) DOES NOT IMPROVE RENAL-FUNCTION IN HEPATIC TRANSPLANT RECIPIENTS

BACKGROUND: Acute renal failure is a frequent complication following o rthotopic hepatic transplantation. A reduction in the synthesis of int rarenal vasodilator prostaglandins has been proposed as having an impo rtant role in the pathogenesis of renal insufficiency associated with hepatic dysfunction, as well as in the nephrotoxicity associated with cyclosporine and FK506 immunosuppressive therapy, Therefore, administr ation of vasodilator prostaglandins may improve renal function followi ng hepatic transplantation. This study was designed to determine the e ffect of continuous intravenous alprostadil (prostaglandin ii) on post operative renal function in hepatic transplant patients, STUDY DESIGN: In a randomized, double-blind, placebo-controlled trial, 21 patients who had undergone orthotopic hepatic transplantation and had a measure d postoperative glomerular filtration rate (GFR) of less than 50 mL/mi nute received intravenous alprostadil at 0.6 mu g/kg/hour or placebo f or five days, Glomerular filtration rate and effective renal plasma fl ow (ERPF) were measured by a single-injection clearance method using a radionuclide agent in 53 patients within 12 hours after admission to our surgical intensive care unit, Usual postoperative care was not mod ified, Radionuclide GFR and ERPF measurements were repeated on postope rative day 3, Serum creatinine was measured preoperatively and postope ratively on day 3 and on day 5, A 24-hour serum creatinine clearance w as measured on days 1, 5, and 14, Urine output was recorded hourly dur ing the infusion period, RESULTS: Ten patients received alprostadil, a nd 11 patients received placebo, There was a significant increase in G FR and ERPF in both groups on postoperative day 3 as compared with bas eline values, There was no difference in GFR and ERPF between the two groups on day 3 (48+/-18 and 246+/-68 mL/minute in the alprostadil gro up compared with 53+/-17 and 270+/-131 mL/minute in the placebo group) , Serum creatinine levels increased on day 3 in both groups, but retur ned to baseline by day 5, CONCLUSIONS: These results indicate that a r eversible decrease in GFR is common in hepatic transplant patients dur ing the postoperative period, Administration of a continuous intraveno us infusion of alprostadil in the immediate postoperative period had n o effect renal function when compared with placebo.