Renal management

Renal dysfunction following orthotopic liver transplantation usually represents a combination of pre-existing renal injury, acute tubular necrosis, and nephrotoxins. It is associated with increased mortality (.Ishitani eí..Q.L 1993). The most important preventative measures are maintenance of a normal perfusion pressure and an adequate cardiac output, and avoidance of the abdominal compartment syndrome. The role of renal dose dopamine remains controversial. Daily cyclosporine A and aminoglycoside antibiotic monitoring are essential. In the absence of an alternative cause, deteriorating renal function suggests poor graft function, sepsis, or bile leak. Renal replacement therapy should not be delayed, and is best managed using continuous venovenous hemofiltration. Heparin may induce thrombocytopenia; epoprostenol (prostacyclin) may be preferable.

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