Statin-Induced Rhabdomyolysis Associated With Transjugular Intrahepatic Portosystemic Shunt Placement.

Rhabdomyolysis is a known rare and potentially lethal complication of statin use. This toxic effect is potentiated by alterations in hepatic physiology in patients with cirrhosis. Transjugular intrahepatic portosystemic shunt placement has the potential to further compound this effect; yet, examples of this have not previously been described in the literature. We present a case of a patient who experienced statin-induced rhabdomyolysis likely as a direct consequence of transjugular intrahepatic portosystemic shunt placement.

An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy.

BACKGROUND: Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. METHODS: A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. RESULTS: A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg (P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg (P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. CONCLUSION AND RELEVANCE: This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

Calcineurin Inhibitor and Nonsteroidal Anti-inflammatory Drug Interaction: Implications of Changes in Renal Function Associated With Concurrent Use.

Evidence for a drug interaction between calcineurin inhibitors (CNIs) and nonsteroidal anti-inflammatory drugs (NSAIDs) is meager, and the magnitude of risk for adverse renal effects associated with this interaction is unclear. To explicate these uncertainties, sequential measures of kidney function were evaluated in hospitalized adult solid organ or allogeneic hematopoietic stem cell transplant recipients who received maintenance CNI therapy and concurrent treatment with an oral or parenteral NSAID. A comparator group of closely matched transplant recipients on CNI therapy who did not receive NSAID treatment during hospitalization was similarly evaluated. Among inpatients on CNIs, treatment-emergent acute kidney injury occurred in 5 of 41 (12.2%) patients exposed to concurrent NSAIDs and in 7 of 126 (5.6%) of matched patients who were not exposed to NSAIDs (relative risk ratio 2.20, 95% confidence interval 0.74 to 6.54). During hospitalization, an increase in serum creatinine above baseline occurred in 80.5% of patients on CNI therapy who were exposed to NSAIDs as compared with 56.3% of patients on CNIs who were not exposed (P = .001). NSAID administration was an independent predictor for a rapid increase in serum creatinine (P = .026). The event rate for worsened renal function was highest among patients exposed to parenteral ketorolac. Because the likelihood of developing treatment-related worsening of renal function is increased with combined use of CNIs and NSAIDs, concurrent use of these medications is inadvisable. Patients and clinicians should be counseled accordingly.