The Impact of Aprotinin on Renal Function After Liver Transplantation: An Analysis of 1043 Patients

Abstract

Renal dysfunction is frequently seen after orthotopic liver transplantation (OLT).Aprotinin is an antifibrinolytic drug which reduces blood loss during OLT. Recent studies in cardiac surgery suggested a higher risk of postoperative renal complications when aprotinin is used. The impact of aprotinin on renal function after OLT, however, is unknown. In 1043 adults undergoing OLT, we compared postoperative renal function in patients who received aprotinin (n = 653) or not (n = 390). Using propensity score stratification (C-index 0.82) and multivariate regression analysis, aprotinin was identified as a risk factor for severe renal dysfunction within the first week, defined as increase in serum creatinine by ≥ 100% (OR = 1.97, 95% CI = 1.14-3.39; p = 0.02). No differences in renal function were noted at 30 and 365 days postoperatively. Moreover, no significant differences were found in the need for renal replacement therapy (OR = 1.52, 95% CI = 0.94-2.46; p = 0.11) or in 1-year patient survival rate (OR = 1.14, 95% CI = 0.73-1.77; p = 0.64) in patients who received aprotinin or not. In conclusion, aprotinin is associated with a higher risk of transient renal dysfunction in the first week after OLT, but not with a higher need for postoperative renal replacement therapy or an increased risk of mortality.

Combined heart and liver transplantation on cardiopulmonary bypass: report of four cases

“…19,20 No increased risk for hepatic artery thrombosis, venous thromboembolic events, or perioperative mortality has been documented for either of these drugs after liver transplantation, although aprotinin has been identified as a risk factor for severe renal dysfunction within the first week post liver transplantation. 21,22 Recently, aprotinin has been withdrawn from marketing because of safety concerns. 23 Thus, at our institution we have switched to using tranexamic acid for those patients at Epinephrine (lgÁmin -1 ) 5 5 6 -…”

Bleeding in Liver Surgery: Prevention and Treatment

“…However, in the liver transplant population, prospective studies have not caused any safety concerns, and no increased risk for thromboembolic events or renal failure has been noted in liver transplant patients treated with aprotinin. 50,51 Although antifibrinolytics have been studied extensively in liver transplantation, only two prospective studies have examined the efficacy in patients undergoing liver resections. 52,53 In general, improvements in surgical technique and anesthesiologic care seem to be more important in reducing blood loss in patients undergoing partial liver resections than the use of the antifibrinolytic drugs.…”

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

“…Still, no differences in renal function were noted 30 and 365 days, postoperatively. Moreover, there were no significant differences in renal replacement therapy in 1-year patient survival rates with or without aprotinin [58]. Owing to the increased renal dysfunction and mortality in high-risk cardiac surgery, aprotinin was transiently withdrawn from the market.…”