Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil

T. C. Gunning, M. R. Brown, T. H. Swygert, R. Goldstein, B. S. Husberg, G. B. Klintmalm, G. DiBona, A. W. Paulsen, M. A E Ramsay, T. A. Gonwa

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Patients who undergo orthotopic liver transplantation often experience a significant drop in GFR postoperatively. Postulated mechanisms include intraoperative hemodynamic changes, suboptimal renal perfusion during the anhepatic stage, and cyclosporine administration. We undertook a prospective double-blind study to investigate these factors, as well as to determine the protective effects of verapamil on perioperative renal function. Twenty-five patients with normal renal function undergoing OLT received either placebo (n = 13) or verapamil (n = 12) intraoperatively and for six weeks post-OLT. No CsA was administered until after reperfusion of the graft liver, and venovenous bypass (VVB) was utilized in all cases. Patients completing six weeks of the study experienced 61% and 48% decreases in GFR within the placebo and verapamil groups respectively. A significant decrease in GFR occurred in the placebo group between one and six weeks post-OLT, and a significant drop in GFR occurred in the verapamil group by one week post-OLT. Differences between the groups were not significant, however. Systemic, renal, and hepatic hemodynamics were similar at all times between groups, and renal hemodynamics and urine output were unchanged during VVB. We conclude that (1) perioperative factors do not contribute to renal dysfunction post-OLT when VVB is used; (2) VVB preserves renal hemodynamics during the anhepatic phase; (3) CsA is the most likely causative agent for post-OLT renal dysfunction; and (4) intraoperative verapamil serves no protective role, as administered in this study.

Original languageEnglish (US)
Pages (from-to)422-427
Number of pages6
JournalTransplantation
Volume51
Issue number2
StatePublished - 1991
Externally publishedYes

Fingerprint

Verapamil
Liver Transplantation
Kidney
Hemodynamics
Placebos
Liver
Double-Blind Method
Cyclosporine
Reperfusion
Perfusion
Urine
Transplants

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

Gunning, T. C., Brown, M. R., Swygert, T. H., Goldstein, R., Husberg, B. S., Klintmalm, G. B., ... Gonwa, T. A. (1991). Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil. Transplantation, 51(2), 422-427.

Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil. / Gunning, T. C.; Brown, M. R.; Swygert, T. H.; Goldstein, R.; Husberg, B. S.; Klintmalm, G. B.; DiBona, G.; Paulsen, A. W.; Ramsay, M. A E; Gonwa, T. A.

In: Transplantation, Vol. 51, No. 2, 1991, p. 422-427.

Research output: Contribution to journalArticle

Gunning, TC, Brown, MR, Swygert, TH, Goldstein, R, Husberg, BS, Klintmalm, GB, DiBona, G, Paulsen, AW, Ramsay, MAE & Gonwa, TA 1991, 'Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil', Transplantation, vol. 51, no. 2, pp. 422-427.
Gunning TC, Brown MR, Swygert TH, Goldstein R, Husberg BS, Klintmalm GB et al. Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil. Transplantation. 1991;51(2):422-427.
Gunning, T. C. ; Brown, M. R. ; Swygert, T. H. ; Goldstein, R. ; Husberg, B. S. ; Klintmalm, G. B. ; DiBona, G. ; Paulsen, A. W. ; Ramsay, M. A E ; Gonwa, T. A. / Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil. In: Transplantation. 1991 ; Vol. 51, No. 2. pp. 422-427.
@article{cdad49fb857f4ac4b141597a944980c7,
title = "Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil",
abstract = "Patients who undergo orthotopic liver transplantation often experience a significant drop in GFR postoperatively. Postulated mechanisms include intraoperative hemodynamic changes, suboptimal renal perfusion during the anhepatic stage, and cyclosporine administration. We undertook a prospective double-blind study to investigate these factors, as well as to determine the protective effects of verapamil on perioperative renal function. Twenty-five patients with normal renal function undergoing OLT received either placebo (n = 13) or verapamil (n = 12) intraoperatively and for six weeks post-OLT. No CsA was administered until after reperfusion of the graft liver, and venovenous bypass (VVB) was utilized in all cases. Patients completing six weeks of the study experienced 61{\%} and 48{\%} decreases in GFR within the placebo and verapamil groups respectively. A significant decrease in GFR occurred in the placebo group between one and six weeks post-OLT, and a significant drop in GFR occurred in the verapamil group by one week post-OLT. Differences between the groups were not significant, however. Systemic, renal, and hepatic hemodynamics were similar at all times between groups, and renal hemodynamics and urine output were unchanged during VVB. We conclude that (1) perioperative factors do not contribute to renal dysfunction post-OLT when VVB is used; (2) VVB preserves renal hemodynamics during the anhepatic phase; (3) CsA is the most likely causative agent for post-OLT renal dysfunction; and (4) intraoperative verapamil serves no protective role, as administered in this study.",
author = "Gunning, {T. C.} and Brown, {M. R.} and Swygert, {T. H.} and R. Goldstein and Husberg, {B. S.} and Klintmalm, {G. B.} and G. DiBona and Paulsen, {A. W.} and Ramsay, {M. A E} and Gonwa, {T. A.}",
year = "1991",
language = "English (US)",
volume = "51",
pages = "422--427",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Perioperative renal function in patients undergoing orthotopic liver transplantation. A randomized trial of the effects of verapamil

AU - Gunning, T. C.

AU - Brown, M. R.

AU - Swygert, T. H.

AU - Goldstein, R.

AU - Husberg, B. S.

AU - Klintmalm, G. B.

AU - DiBona, G.

AU - Paulsen, A. W.

AU - Ramsay, M. A E

AU - Gonwa, T. A.

PY - 1991

Y1 - 1991

N2 - Patients who undergo orthotopic liver transplantation often experience a significant drop in GFR postoperatively. Postulated mechanisms include intraoperative hemodynamic changes, suboptimal renal perfusion during the anhepatic stage, and cyclosporine administration. We undertook a prospective double-blind study to investigate these factors, as well as to determine the protective effects of verapamil on perioperative renal function. Twenty-five patients with normal renal function undergoing OLT received either placebo (n = 13) or verapamil (n = 12) intraoperatively and for six weeks post-OLT. No CsA was administered until after reperfusion of the graft liver, and venovenous bypass (VVB) was utilized in all cases. Patients completing six weeks of the study experienced 61% and 48% decreases in GFR within the placebo and verapamil groups respectively. A significant decrease in GFR occurred in the placebo group between one and six weeks post-OLT, and a significant drop in GFR occurred in the verapamil group by one week post-OLT. Differences between the groups were not significant, however. Systemic, renal, and hepatic hemodynamics were similar at all times between groups, and renal hemodynamics and urine output were unchanged during VVB. We conclude that (1) perioperative factors do not contribute to renal dysfunction post-OLT when VVB is used; (2) VVB preserves renal hemodynamics during the anhepatic phase; (3) CsA is the most likely causative agent for post-OLT renal dysfunction; and (4) intraoperative verapamil serves no protective role, as administered in this study.

AB - Patients who undergo orthotopic liver transplantation often experience a significant drop in GFR postoperatively. Postulated mechanisms include intraoperative hemodynamic changes, suboptimal renal perfusion during the anhepatic stage, and cyclosporine administration. We undertook a prospective double-blind study to investigate these factors, as well as to determine the protective effects of verapamil on perioperative renal function. Twenty-five patients with normal renal function undergoing OLT received either placebo (n = 13) or verapamil (n = 12) intraoperatively and for six weeks post-OLT. No CsA was administered until after reperfusion of the graft liver, and venovenous bypass (VVB) was utilized in all cases. Patients completing six weeks of the study experienced 61% and 48% decreases in GFR within the placebo and verapamil groups respectively. A significant decrease in GFR occurred in the placebo group between one and six weeks post-OLT, and a significant drop in GFR occurred in the verapamil group by one week post-OLT. Differences between the groups were not significant, however. Systemic, renal, and hepatic hemodynamics were similar at all times between groups, and renal hemodynamics and urine output were unchanged during VVB. We conclude that (1) perioperative factors do not contribute to renal dysfunction post-OLT when VVB is used; (2) VVB preserves renal hemodynamics during the anhepatic phase; (3) CsA is the most likely causative agent for post-OLT renal dysfunction; and (4) intraoperative verapamil serves no protective role, as administered in this study.

UR - http://www.scopus.com/inward/record.url?scp=0026019426&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026019426&partnerID=8YFLogxK

M3 - Article

C2 - 1994537

AN - SCOPUS:0026019426

VL - 51

SP - 422

EP - 427

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 2

ER -