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Rhabdomyolysis and renal function impairment after isolated limb perfusion—Comparison between the effects of perfusion with rhTNFα and a ‘triple-drug’ regimen

  • P. Hohenberger
    Correspondence
    Correspondence to P. Hohenberger.
    Affiliations
    Division of Surgery and Surgical Oncology, Robert-Rossle Hospital, Berlin, Germany

    Tumor Institute, Max-Delbruck Center for Molecular Medicine, Virchow Klinikum, Humboldt University of Berlin, Lindenberger Weg 80, D-13122 Berlin, Germany
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  • J. Haier
    Affiliations
    Division of Surgery and Surgical Oncology, Robert-Rossle Hospital, Berlin, Germany

    Tumor Institute, Max-Delbruck Center for Molecular Medicine, Virchow Klinikum, Humboldt University of Berlin, Lindenberger Weg 80, D-13122 Berlin, Germany
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  • P.M. Schlag
    Affiliations
    Division of Surgery and Surgical Oncology, Robert-Rossle Hospital, Berlin, Germany

    Tumor Institute, Max-Delbruck Center for Molecular Medicine, Virchow Klinikum, Humboldt University of Berlin, Lindenberger Weg 80, D-13122 Berlin, Germany
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      Abstract

      The aim of this study was to monitor serum and perfusate levels of myoglobin (MB) and creatine kinase (CK) during isolated limb perfusion (ILP) in order to identify those at risk of renal failure. We investigated the release of MB and CK in 40 patients who underwent ILP for melanoma (n = 15) or sarcoma (n = 25) using rhTNFα/melphalan (n = 28) or a triple-drug regimen (n = 12). Serial determinations of CK and MB were performed in both perfusate and systemic circulation during and after ILP and renal function was assessed. A significant increase of MB could be detected in the perfusate during ILP. After ILP, an up to 100-fold increase with a double peak of MB at 4 h and 24 h postoperatively was observed. The maximum elevation of serum activity of CK was at 30 h. The increase for both proteins was highly significant (P < 0.001). ILP with rhTNFα/melphalan yielded significantly (P < 0.001) higher serum values of MB and CK and also the impairment of the renal function was more pronounced. The peak values of MB after ILP occur early and allow the patients most at risk of developing renal failure to be identified. Rhabdomyolysis can be detected early by determination of MB from the perfusate. Further measurements twice daily for 2–3 days post ILP from serum samples as well as daily assessment of MB in the urine is helpful for detecting myoglobinuria and imminent renal failure.

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