RHABDOMYOLYSIS AND RENAL-FUNCTION IMPAIRMENT AFTER ISOLATED LIMB PERFUSION - COMPARISON BETWEEN THE EFFECTS OF PERFUSION WITH RHTNF-ALPHA AND A TRIPLE-DRUG REGIMEN

The aim of this study was to monitor serum and perfusate levels of myo globin (MB) and creatine kinase (CK) during isolated limb perfusion (I LP) in order to identify those at risk of renal failure. We investigat ed the release of MB and CK in 40 patients who underwent ILP for melan oma (n = 15) or sarcoma (n = 25) using rhTNF alpha/melphalan (n = 28) or a triple-drug regimen (n = 12). Serial determinations of CK and MB were performed in both perfusate and systemic circulation during and a fter ILP and renal function was assessed. A significant increase of MB could be detected in the perfusate during ILP. After ILP, an up to 10 0-fold increase with a double peak of MB at 4 h and 24 h postoperative ly was observed. The maximum elevation of serum activity of CK was at 30 h. The increase for both proteins was highly significant (P < 0.001 ). ILP with rhTNF alpha/melphalan yielded significantly (P < 0.001) hi gher serum values of MB and CK and also the impairment of the renal fu nction was more pronounced. The peak values of MB after ILP occur earl y and allow the patients most at risk of developing renal failure to b e identified. Rhabdomyolysis can be detected early by determination of MB from the perfusate. Further measurements twice daily for 2-3 days post ILP from serum samples as well as daily assessment of MB in the u rine is helpful for detecting myoglobinuria and imminent renal failure . (C) 1997 Elsevier Science Ltd.