Effect of ulinastatin on acute kidney injury in pediatric patients undergoing living-donor liver transplantation

Objective To evaluate the effect of ulinastatin on acute kidney injury in the pediatric patients undergoing living-donor liver transplantation(LDLT). Methods Forty pediatric patients with congenital biliary atresia, aged 5-14 months, weighing 5.5-10.0 kg, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, scheduled for elective LDLT, were divided into either control group(group C, n=20)or ulinastatin group(group U, n=20)using a random number table.Ulinastatin 20 000 U/kg was diluted to 10 000 U/ml in normal saline and then intravenously infused in 2 parts(1/2 was given immediately before skin incision; 1/2 at 5 min before portal vein declamping)in group U. The equal volume of normal saline was given instead of ulinastatin at the same time points in group C. Immediately before skin incision(T0, baseline), at 30 min of anhepatic period(T1), at 1 h of neohepatic period(T2), at the end of surgery(T3)and at 24 h after surgery(T4), blood samples from the central vein and urine specimens were collected for determination of creatinine(Cr)and blood urea nitrogen(BUN)concentrations in serum (by colorimetric assay)and β2-microglobulin(β2-MG)concentrations in serum and urine(using immunoturbidimetric method). The urine volume, requirement for dopamine and diuretics and occurrence of adverse cardiovascular events(hypotension, myocardial ischemia, ventricular premature beat)were recorded during surgery.The changing rates of Cr, BUN and β2-MG concentrations in serum and β2-MG concentrations in urine were calculated at T1-4. Results Compared with group C, the urine volume was significantly increased, Cr and β2-MG concentrations in serum, β2-MG concentrations in urine and the changing rates were decreased at T2-4, serum BUN concentrations and the changing rates were decreased at T3, 4(P 0.05). Conclusion Ulinastatin can attenuate acute kidney injury in the pediatric patients undergoing LDLT. Key words: Trypsin inhibitors; Liver transplantation; Child; Kidney; Prognosis