The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study.
Ibrahim N, Hasanin A, et al.Indian Journal of Anaesthesia 2015; 59(3): 156-164.
Aims
To assess the impact of peri‑operative terlipressin intravenous infusion on liver donor liver transplantation (LDLT) in respect to the systemic and hepatic haemodynamics.
Interventions
Patients in the terlipressin treatment group received the infusion at the beginning of surgery at a dose of 1.0 μg/kg/h and later titrated (1.0–4.0 μg/kg/h) to maintain a mean arterial pressure (MAP). Patients in the control group received a placebo of crystalloids in place of terlipressin.
Participants
50 patients aged 18–55 years with model of end stage liver disease score between 12 and 20 and a portal vein of adequate length after transplantation
Outcomes
Outcomes measured were heart rate, arterial blood pressure, central venous pressure, doppler parameters, renal function, stroke volume, cardiac output, systemic vascular resistance, portal venous blood flow, liver enzymes, catecholamine support, hepatic artery resistance index, urine output and lactate.
Follow-up
4 days
CET Conclusions
This was a study of intra-operative terlipressin to maintain mean arterial pressure (MAP) during live-donor liver transplant. Trans-oesophageal doppler was used intra-operatively. The control group received crystalloids instead of terlipressin. In both groups if MAP dropped below 65mmHg noradrenaline infusion was started. The terlipressin group were less likely to require noradrenaline. The terlipressin group had lower AST and ALT levels for the first 4 days and one less day in ICU on average. The study was adequately randomised and allocation concealed, but was not blinded. A power calculation was done based on predicted systemic vascular resistance. It seems that the study is one of intra-operative blood pressure control rather than the therapeutic effect of the drug itself.
Data analysis
Per protocol analysis
Trial registration
Pan African Clinical Trials Registry of South African Cochrane Registry - PACTR201402000752252