The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study

Ibrahim, Nagwa; Hasanin, Ashraf S.; Allah, Sabry Abd; Sayed, Eman; Afifi, Mohamed; Yassen, Khaled; Saber, WesamEldin I. A.; Khalil, Magdy T.

doi:10.4103/0019-5049.153037

Cited by 20 publications

(11 citation statements)

References 24 publications

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“…[47][48][49] Infusions of terlipressin have been used in doses ranging 1-3 μg/kg perioperatively titrated to keep the MAP >65 mm Hg and SVR index <2600 dyn.s/ cm 5 /m 2 . 47,48,50 The beneficial impact of terlipressin on portal pressures occurs within an hour after administration and lasts for the period of infusion postoperatively. [46][47][48] Although there are several conflicting findings including 1 randomized controlled trial (RCT) trial that did not show any difference in postreperfusion portal pressures but documented a decrease in portal flow velocities, 49 and a retrospective analysis of 86 patients that did not demonstrate any impact of terlipressin on cardiac index, SVR index, or renal outcomes, terlipressin infusion in the preanhepatic to the postoperative period can provide beneficial changes in the portal pressures, portal blood flow velocities, and systemic hemodynamic parameters.…”

Section: Terlipressinmentioning

confidence: 99%

“…[46][47][48][49][50] Terlipressin infusions can reduce the length of ICU stay and length of hospital stay. 47,49,50 See Table 2 for a summary of the recommendations for intraoperative modifications.…”

Section: Terlipressinmentioning

confidence: 99%

“…47,48,50 The beneficial impact of terlipressin on portal pressures occurs within an hour after administration and lasts for the period of infusion postoperatively. 46-48…”

Section: Intraoperative Modificationsmentioning

confidence: 99%

“…Several studies demonstrated that terlipressin administration increases systemic vascular resistance (SVR), MAP, and cardiac output; therefore, it can decrease the need for norepinephrine. 46,47 Fayed et al 48 demonstrated that terlipressin infusion significantly decreased hepatic and renal arterial resistive indices and portal vein flow and improved low SVR and MAP. Infusions of terlipressin without a bolus were reported to improve the metabolic acidosis in the splanchnic circulation.…”

Section: Intraoperative Modificationsmentioning

confidence: 99%

“…46 Liver functions are not negatively affected with use of terlipressin infusions. [47][48][49] Infusions of terlipressin have been used in doses ranging 1-3 μg/kg perioperatively titrated to keep the MAP >65 mm Hg and SVR index <2600 dyn.s/ cm 5 /m 2 . 47,48,50 The beneficial impact of terlipressin on portal pressures occurs within an hour after administration and lasts for the period of infusion postoperatively.…”

Section: Terlipressinmentioning

confidence: 99%

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Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Chadha,

Sakai,

Rajakumar

et al. 2023

Transplantation

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Background. During the perioperative period of living donor liver transplantation, anesthesiologists and intensivists may encounter patients in receipt of small grafts that puts them at risk of developing small for size syndrome (SFSS). Methods. A scientific committee (106 members from 21 countries) performed an extensive literature review on aspects of SFSS with proposed recommendations. Recommendations underwent a blinded review by an independent expert panel and discussion/voting on the recommendations occurred at a consensus conference organized by the International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplantation Society of India. Results. It was determined that centers with experience in living donor liver transplantation should utilize potential small for size grafts. Higher risk recipients with sarcopenia, cardiopulmonary, and renal dysfunction should receive small for size grafts with caution. In the intraoperative phase, a restrictive fluid strategy should be considered along with routine use of cardiac output monitoring, as well as use of pharmacologic portal flow modulation when appropriate. Postoperatively, these patients can be considered for enhanced recovery and should receive proactive monitoring for SFSS, nutrition optimization, infection prevention, and consideration for early renal replacement therapy for avoidance of graft congestion. Conclusions. Our recommendations provide a framework for the optimal anesthetic and critical care management in the perioperative period for patients with grafts that put them at risk of developing SFSS. There is a significant limitation in the level of evidence for most recommendations. This statement aims to provide guidance for future research in the perioperative management of SFSS.

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Section: Terlipressinmentioning

confidence: 99%

Section: Terlipressinmentioning

confidence: 99%

“…47,48,50 The beneficial impact of terlipressin on portal pressures occurs within an hour after administration and lasts for the period of infusion postoperatively. 46-48…”

Section: Intraoperative Modificationsmentioning

confidence: 99%

Section: Intraoperative Modificationsmentioning

confidence: 99%

Section: Terlipressinmentioning

confidence: 99%

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Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Chadha,

Sakai,

Rajakumar

et al. 2023

Transplantation

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Double‐blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation

Reddy

Kaliamoorthy²,

Rajakumar³

et al. 2017

Liver Transpl

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Perioperative terlipressin (Tp) during living donor liver transplantation (LDLT) has been shown to reduce intraoperative portal pressures and improve renal function. Its role and safety profile have never been evaluated in a double-blind randomized controlled trial (RCT). The aim was to evaluate the hemodynamic effects, clinical benefits, and safety of perioperative Tp infusion in adult LDLT. This was a single-center double-blind RCT. Consenting adults with chronic liver disease and low risk of posttransplant renal dysfunction undergoing their first LDLT were randomized. The study group (terlipressin group [TpG]) received an initial bolus of Tp during surgery followed by a Tp infusion for 72 hours in the postoperative period. The placebo group (PbG) received a saline infusion. The primary endpoint was portal pressure after arterial reperfusion. Multiple intraoperative and postoperative variables served as secondary endpoints. A total of 41 patients were enrolled in the trial (TpG, 21; PbG, 20). There were no significant differences in intraoperative portal pressures, blood loss, fluid requirement, vasopressor requirement, or urine output. Peak intraoperative and end of surgery lactate levels were significantly higher in the Tp group. There was no difference in postoperative liver function tests. Incidence of acute kidney injury as assessed by Risk, Injury, Failure, Loss, and End-Stage Kidney Disease criteria was lower in the Tp group (27% versus 60%; P = 0.04). The TpG had less postoperative ascites, a lower need for percutaneous interventions, and a shorter hospital stay. Incidence of bradycardia requiring pharmacological intervention and withdrawal from study was significantly higher in the TpG. In conclusion, this study has not demonstrated a reduction in postreperfusion portal pressure with Tp. However, Tp infusion reduced postoperative ascitic drain output resulting in less frequent percutaneous interventions and reduced hospital stay. Intraoperative hyperlactatemia and symptomatic bradycardia are major concerns. Its use should be restricted to patients with high-volume ascites, and it needs close monitoring during drug infusion. Liver Transplantation 23 1007-1014 2017 AASLD.

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Anaesthesia for Live Donor Hepatectomy

Yassen

2020

Anesthesia for Hepatico-Pancreatic-Biliary Surgery and Transplantation

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The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study

Cited by 20 publications

References 24 publications

Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Double‐blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation

Anaesthesia for Live Donor Hepatectomy

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