Effect of perioperative steroids on renal function after liver transplantation*

Abstract

SummarySubclinical renal dysfunction is thought to occur as a systemic manifestation of ischaemia-reperfusion injury of other organs. Liver transplantation is associated with major ischaemia-reperfusion injury. Thirty-four patients undergoing elective liver transplantation were randomly allocated to receive either saline or 10 mg.kg

Dexamethasone Ameliorates Renal Ischemia-Reperfusion Injury

“…Indeed, it is significantly less than those found after intravenous pulse glucocorticoid therapy used in a few major vascular surgical studies [7][8][9][10] to protect against renal IRI, where serum concentrations can reach 60 to 200 M. 37 The plausible mechanism of GR-mediated activation of the MEK/ ERK 1/2 module in proximal tubular cells is partly speculative. The cytosolic nonliganded GR is a part of a multiprotein complex in which, among other proteins, two molecules of heat shock protein 90 (hsp90), as well as one molecule each of hsp70 and hsp56 are known to be included.…”

“…4 -6 For decades, glucocorticoids (GCs) have been successfully used in the treatment of numerous clinical conditions for their anti-inflammatory and immunosuppressive effects. GCs have been studied as renoprotective agents in a few small postvascular surgical studies and in varied experimental settings [7][8][9][10] associated with renal IRI. However, the effects of GCs on renal IRI have never been thoroughly studied.…”

The role of pharmacological steroid therapy in preservation of renal function in severely injured patients requiring massive transfusion

“…Similarly following cardiac surgery, the use of MP was shown by Gormley et al to be associated with a reduction in plasma pro-inflammatory response, urinary anti-inflammatory cytokines, magnitude, and duration of renal injury [9][10][11]. Moreover, Turner et al showed that, in the setting of ischemia reperfusion associated with liver transplantation, peri-operative MP conferred protection against both renal and hepatic dysfunction [12]. These multiple examples of myocardial, renal, and hepatic protection afforded by pharmacologic doses of GC all occur in clinical settings where there is a significant reduction in organ perfusion.…”

In defense of the administration of perioperative steroids in liver transplantation

“…In addition, these trials have demonstrated that the administration of perioperative steroids is not associated with adverse effects of chronic steroid use. 3 Turner et al 4 investigated the effect of preoperative methylprednisolone (MP) as a modifier of injury of distant organs consequent to liver I/R during LT and on graft function. Thirty-four patients undergoing elective LT were randomly allocated to receive either saline or 10 mg/kg MP at induction of anesthesia.…”

“…6,7 Even though the exact molecular-biologic mechanisms of steroid action on hepatic I/R injury remain partially unknown, several pieces of experimental and clinical evidence support the hypothesis that preoperative administration of MP may preserve liver function following warm and cold hepatic I/R and has no apparent negative effects on hepatic regeneration. 4,5,8,9 Although most data seem to support the beneficial effects of MP on hepatic I/R, it has been reported that dexamethasone may inhibit early regenerative response and enhance hepatic I/R injury after cold preservation and transplantation. 10 However, different steroids (such as hydrocortisone, dexamethasone, or MP) have different anti-inflammatory and antiproliferative properties, and this makes an appropriate comparison more difficult.…”