THE EFFECT OF APROTININ ON RENAL FUNCTION IN ORTHOTOPIC LIVER TRANSPLANTATION

In the European Multicenter Study on the Use of Aprotinin in Liver Transplantation (EMSALT), a randomized, double-blind, placebo-con- trolled, prospective study, we demonstrated that apro- tinin significantly reduces intraoperative blood loss during orthotopic liver transplantation (OLT). Aproti- nin is metabolized in the kidney and potentially neph- rotoxic at high concentrations. Renal insufficiency is a common and serious complication after OLT. It is un- known whether aprotinin increases the risk of renal failure after OLT. Methods. We analyzed intraoperative urine output, need for postoperative dialysis, perioperative serum creatinine levels, and creatinine clearance in 93 pa- tients enrolled in EMSALT, receiving a high dose of aprotinin, a regular dose, or placebo. Results. Peak increase in serum creatinine exceed- ing 0.5 mg/dl during one of the postoperative days occurred in 11 (35%) patients in the placebo group, in 11 (34%) patients in the high-dose group, but only in 1 (3%) patient in the regular-dose group (P0.007). Fur- thermore, a perioperative decrease in creatinine clearance was seen in the placebo group (–23.910.1 ml/min) but not in both high-dose (–1.613.3 ml/min) and regular-dose (9.710.3 ml/min) groups (P<0.02 comparing regular-dose and placebo group). Conclusions. Despite its potential nephrotoxicity, the use of aprotinin for reducing blood loss during OLT does not lead to a higher incidence of postopera- tive renal insufficiency. In combination with the ob- served reduction in blood loss, these findings support the prophylactic use of regular-dose aprotinin during OLT.