N Fayed1, E K Refaat, T E Yassein, M Alwaraqy. 1. Department of Anesthesia, National Liver Institute, Menofiya University, Shebeen Alkoom, Egypt. Electronic address: drnirmeena@yahoo.com.
Abstract
BACKGROUND: End-stage liver disease is associated with marked hemodynamic disturbances that are further aggravated during liver transplantation. Terlipressin has been shown to be effective in the management of sepsis-induced hypotension and hepatorenal syndrome and recently has been tried as infusion during liver transplantation. This study assessed the effect of intraoperative and postoperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during adult living donor liver transplantation. METHODS:Eighty recipients were randomly allocated into control (C group; n=40) and terlipressin (TP group; n=40), in which, terlipressin infusion was started at the beginning of surgery at a dose of 3 μg kg(-1) h(-1) to be reduced to 1.5 μg kg(-1) h(-1) after reperfusion and continued for 3 postoperative days; vasoactive agents were used as appropriate in all patients. Systemic hemodynamics, hepatic and renal arterial resistive indices (HARI, RARI), and portal venous blood flow (PBF) were compared between both groups intraoperatively and for 5 postoperative days. RESULTS: With terlipressin infusion, there were significant increases in both mean arterial pressure and systemic vascular resistance (P<.001), whereas heart rate and cardiac output decreased significantly (P<.001) throughout the study period compared with the C group. Vasoconstrictor drugs required during reperfusion were significantly lower in the TP group. There was a significant decrease in HARI, RARI, and portal venous blood flow in the TP group compared with the C group throughout the study period. There was no significant difference between both groups regarding liver function tests and serum lactate, whereas renal function tests were significantly better in the TP group. CONCLUSION:Terlipressin infusion significantly decreased HARI, RARI, and portal vein flow and improved low systemic vascular resistance and mean arterial pressure. It helped to reduce intraoperative vasoactive support and might improve postoperative renal function.
RCT Entities:
BACKGROUND: End-stage liver disease is associated with marked hemodynamic disturbances that are further aggravated during liver transplantation. Terlipressin has been shown to be effective in the management of sepsis-induced hypotension and hepatorenal syndrome and recently has been tried as infusion during liver transplantation. This study assessed the effect of intraoperative and postoperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during adult living donor liver transplantation. METHODS: Eighty recipients were randomly allocated into control (C group; n=40) and terlipressin (TP group; n=40), in which, terlipressin infusion was started at the beginning of surgery at a dose of 3 μg kg(-1) h(-1) to be reduced to 1.5 μg kg(-1) h(-1) after reperfusion and continued for 3 postoperative days; vasoactive agents were used as appropriate in all patients. Systemic hemodynamics, hepatic and renal arterial resistive indices (HARI, RARI), and portal venous blood flow (PBF) were compared between both groups intraoperatively and for 5 postoperative days. RESULTS: With terlipressin infusion, there were significant increases in both mean arterial pressure and systemic vascular resistance (P<.001), whereas heart rate and cardiac output decreased significantly (P<.001) throughout the study period compared with the C group. Vasoconstrictor drugs required during reperfusion were significantly lower in the TP group. There was a significant decrease in HARI, RARI, and portal venous blood flow in the TP group compared with the C group throughout the study period. There was no significant difference between both groups regarding liver function tests and serum lactate, whereas renal function tests were significantly better in the TP group. CONCLUSION: Terlipressin infusion significantly decreased HARI, RARI, and portal vein flow and improved low systemic vascular resistance and mean arterial pressure. It helped to reduce intraoperative vasoactive support and might improve postoperative renal function.
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