Estimation of creatinine clearance in end-stage liver disease.

BACKGROUND: Estimation of renal function in patients with end-stage liver disease (ESLD) is complicated by several factors. OBJECTIVE: To develop a practical and relatively inexpensive method for estimating creatinine production and clearance in patients with ESLD. METHODS: Serum creatinine concentrations and urinary excretion of creatinine were measured in 27 patients with moderate-to-severe liver disease with the goal of developing equations to predict creatinine clearance from serum creatinine. Subjects were studied during an initial evaluation for a liver transplant program. Two 24 hour urine specimens were collected along with 3 serum samples over a 2 day evaluation period. Serum and urine creatinine concentrations were determined using both a modified Jaffé (autoanalyzer) method and an HPLC method. The data were analyzed using nonlinear mixed-effects modeling. RESULTS: Considering both statistical criteria and physiological conventions through allometric scaling theory, creatinine clearance (mL/min) in males can be estimated as (80/serum creatinine) x (actual body weight/70)0.75. For females, the same equation is valid, but the result is multiplied by 0.661. A simplified equation without the exponent is presented, along with equations that are appropriate when an HPLC assay is used for greater specificity. CONCLUSIONS: These equations offer potential for improved estimation of creatinine clearance in patients with liver impairment; however, they need further validation using an independent group of subjects.

Liver Transplantation Modern techniques in donor and recipient operations.

Pacific Transplant Institute, California Pacific Medical Center, San Francisco Orthotopic hepatic transplantation provides hope for patients with irreversible liver disease, and the operation is becoming more accepted by the medical community and the public in general. Still, the operation is difficult and the postoperative and long-term management can be rather complex. Unlike pancreas, kidney and heart transplantation, liver transplantation lacks a back-up system, such as Insulin, dialysis or a ventricular support device, if graft failure occurs. Therefore, the Slightest error in the management of the patient after hepatic transplantation may prove fatal. Complications during the post-operative period often originate from the time of the procurement and/or transplantation operations. Thus, good techniques are crucial for a satisfactory outcome.