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19 September 2017 : Original article  

Perioperative Ketorolac Use: A Potential Risk Factor for Renal Dysfunction After Live-Donor Nephrectomy

Kazuhiro Takahashi1ABCDEF*, Anita K. Patel2ABCDEF, Shunji Nagai1ABCDE, Mohamed Safwan1BE, Krishna G. Putchakayala1BE, William J. Kane1BE, Lauren E. Malinzak1AB, Jason E. Denny1AB, Atsushi Yoshida1AB, Dean Y. Kim1ADEG

DOI: 10.12659/AOT.904762

Ann Transplant 2017; 22:563-569

Abstract

BACKGROUND: Ketorolac is a nonsteroidal anti-inflammatory drug indicated for pain control after surgeries in many fields. The aim of this study was to evaluate the impact of ketorolac use after live-donor nephrectomy (LDN).

MATERIAL AND METHODS: We reviewed data on 251 patients who underwent laparoscopic LDN from April 2008 to March 2016. Ketorolac was given to 167 patients intraoperatively or postoperatively within 24 h after LDN. Glomerular filtration rate (GFR) percentage was defined as postoperative GFR/preoperative GFR. GFR and GFR percentage at 2 weeks, 6 months, and 1 year after LDN were compared between patients with and without ketorolac administration. Multivariate analysis was performed to identify risk factors for low GFR percentage 1 year after LDN.

RESULTS: GFR at 1 year was significantly lower in patients who received ketorolac than in those who did not (62 ml/min/1.73 m² vs. 73 ml/min/1.73 m², P<0.01). The differences in GFR and GFR percentage between 2 weeks and 1 year after LDN was significantly lower in the ketorolac group (GFR; 3.0 ml/min/1.73 m² vs. 14.0 ml/min/1.73 m², P<0.01; GFR percentage; 2.0% vs. 12.0%, P<0.01). Urinary albumin/creatinine ratio 1 year after LDN was significantly higher in the ketorolac group compared to the non-ketorolac group (8.6 mg/g vs. 12.6 mg/g, P=0.02). Multivariate analysis revealed that ketorolac use was an independent risk factor for low GFR percentage 1 year after LDN (odds ratio 1.38).

CONCLUSIONS: Ketorolac appears to be a risk factor for renal dysfunction in the long term after LDN. Prospective clinical trials are needed to reassess its safety.

Keywords: Glomerular Filtration Rate, Ketorolac, Nephrectomy, Renal Insufficiency, Chronic

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358