Perioperative clinical practice in liver transplantation: a cross-sectional survey

Carrier, François M.; Vincelette, Christian; Trottier, Helen; Amzallag, Éva; Carr, Adrienne; Chaudhury, Prosanto; Dajani, Khaled; Fugère, René; Giard, Jeanne-Marie; Gonzalez-Valencia, Nelson; Joosten, Alexandre; Kandelman, Stanislas; Karvellas, Constantine; McCluskey, Stuart A.; Özelsel, Timur; Park, Jeieung; Simoneau, Ève; Chassé, Michaël

doi:10.1007/s12630-023-02499-y

Cited by 4 publications

(2 citation statements)

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“…Such blood-sparing effect may be a pathway to improving outcomes after liver transplantation and should be further explored in well-conducted large RCTs. 40 The strengths of this systematic review were the broad evaluation of all available evidence regarding different vasoactive drugs used in liver transplantation using a very extensive and sensitive literature search and rigorous analyses. However, our review has some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…We selected norepinephrine as a common comparator for the vasoconstrictor category because it is most anesthesiologists' preferred choice. 40 We used the same analytical approach when only 2 interventions were compared for any outcome for consistent reporting. We estimated the global inconsistency using the Q statistic and the I 2 score and explored inconsistency across the network using the Q statistic for within-design heterogeneity and between designs inconsistency and the Separating Indirect from Direct Evidence approach for local incoherence.…”

Section: Main Analysesmentioning

confidence: 99%

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Intraoperative Vasoactive Medications and Perioperative Outcomes in Liver Transplantation: A Systematic Review and Network Meta-analyses

et al. 2023

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We conducted a systematic review and network meta-analyses evaluating the effects of different intraoperative vasoactive drugs on acute kidney injury (AKI) and other perioperative outcomes in adult liver transplant recipients. We searched multiple electronic databases using words from the “liver transplantation” and “vasoactive drug” domains. We included all randomized controlled trials conducted in adult liver transplant recipients comparing 2 different intravenous vasoactive drugs or 1 against a standard of care that reported AKI, intraoperative blood loss, or any other postoperative outcome. We conducted 4 frequentist network meta-analyses using random effect models, based on the interventions’ mechanism of action, and evaluated the quality of evidence (QoE) using Grading of Recommendations, Assessment, Development, and Evaluations recommendations. We included 9 randomized controlled trials comparing different vasopressor drugs (vasoconstrictor or inotrope), 3 comparing a somatostatin infusion (or its analogues) to a standard of care, 11 comparing different vasodilator infusions together or against a standard of care, and 2 comparing vasoconstrictor boluses at graft reperfusion. Intravenous clonidine was associated with shorter duration of mechanical ventilation, intensive care unit, and hospital length of stay (very low QoE), and some vasodilators were associated with lower creatinine level 24 h after surgery (low to very low QoE). Phenylephrine and terlipressin were associated with less intraoperative blood loss when compared with norepinephrine (low and moderate QoE). None of the vasoactive drugs improve any other postoperative outcomes, including AKI. There is still important equipoise regarding the best vasoactive drug to use in liver transplantation for most outcomes. Further studies are required to better inform clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Main Analysesmentioning

confidence: 99%