The use of terlipressin during living donor liver transplantation: Effects on systemic and splanchnic hemodynamics and renal function*

Mukhtar, Ahmed; Salah, Maged; Aboulfetouh, Fawzia; Obayah, Gihan; Samy, Maha M.; Hassanien, Azza; Bahaa, Mohamed; Abdelaal, Amr; Fathy, Mohamed; Saeed, Hany; Rady, Mohamed Y.; Mostafa, Ibrahim; El-Meteini, Mahmoud

doi:10.1097/ccm.0b013e3182120842

Cited by 64 publications

(84 citation statements)

References 17 publications

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“…Nowadays, there is an increased awareness that distribution of blood volume is altered in patients with cirrhosis (28). We learned over time that rapid expansion of blood volume results in a blunted cardiac output increase and splanchnic pooling when portal hypertension is present (28,38). Knowing this, we decided to change our practice for OLT.…”

Section: Discussionmentioning

confidence: 92%

Transfusion Rate for 500 Consecutive Liver Transplantations

et al. 2012

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Section: Discussionmentioning

confidence: 92%

Transfusion Rate for 500 Consecutive Liver Transplantations

et al. 2012

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“…In 1 study, the inclusion criteria were determined by anatomical factors [13], whereas patients in the other studies were included according to clinical conditions (e.g. MELD score, portal hypertension, and the Child-Turcotte-Pugh grade) [14,15]. There were no significant differences in the age and sex of patients between the 2 groups in all the studies.…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

“…Dopamine, norepinephrine, and/or dobutamine was administered to maintain a MAP of >65 mm Hg in the control. In the other studies, the control group received norepinephrine and epinephrine to maintain the hemodynamics; in the terlipressin group, the terlipressin infusion was started at a dose of 3 mg/kg per hour to maintain an MAP of >65 mm Hg, and the dose was reduced to 1.5 mg/ kg per hour after reperfusion, which continued until the third postoperative day [13], or terlipressin was administered as an initial bolus dose of 1 mg over 30 min followed by a continuous infusion of 2 mg/kg per hour for 2 days [15].…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

Effect of Perioperative Terlipressin on Postoperative Renal Function in Patients Who Have Undergone Living Donor Liver Transplantation: A Meta-Analysis of Randomized Controlled Trials

Won¹,

Kim²,

Lim³

et al. 2015

Transplantation Proceedings

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“…In a randomized, controlled study, Mukhtar et al studied the effects of terlipressin versus saline on splanchnic hemodynamics and postoperative renal function in patients undergoing liver transplantation [36]. Terlipressin improved renal function, as serum levels of creatinine and cystatin C were significantly lower in the terlipressin group during the two first postoperative days.…”

Section: Discussionmentioning

confidence: 99%

Renal function and oxygenation are impaired early after liver transplantation despite hyperdynamic systemic circulation

et al. 2017

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BackgroundAcute kidney injury (AKI) occurs frequently after liver transplantation and is associated with the development of chronic kidney disease and increased mortality. There is a lack of data on renal blood flow (RBF), oxygen consumption, glomerular filtration rate (GFR) and renal oxygenation, i.e. the renal oxygen supply/demand relationship, early after liver transplantation. Increased insight into the renal pathophysiology after liver transplantation is needed to improve the prevention and treatment of postoperative AKI. We have therefore studied renal hemodynamics, function and oxygenation early after liver transplantation in humans.MethodsSystemic hemodynamic and renal variables were measured during two 30-min periods in liver transplant recipients (n = 12) and post-cardiac surgery patients (controls, n = 73). RBF and GFR were measured by the renal vein retrograde thermodilution technique and by renal extraction of Cr-EDTA (= filtration fraction), respectively. Renal oxygenation was estimated from the renal oxygen extraction.ResultsIn the liver transplant group, GFR decreased by 40% (p < 0.05), compared to the preoperative value. Cardiac index and systemic vascular resistance index were 65% higher (p < 0.001) and 36% lower (p < 0.001), respectively, in the liver transplant recipients compared to the control group. GFR was 27% (p < 0.05) and filtration fraction 40% (p < 0.01) lower in the liver transplant group. Renal vascular resistance was 15% lower (p < 0.05) and RBF was 18% higher (p < 0.05) in liver transplant recipients, but the ratio between RBF and cardiac index was 27% lower (p < 0.001) among the liver-transplanted patients compared to the control group. Renal oxygen consumption and extraction were both higher in the liver transplants, 44% (p < 0.01) and 24% (p < 0.05) respectively.ConclusionsDespite the hyperdynamic systemic circulation and renal vasodilation, there is a severe decline in renal function directly after liver transplantation. This decline is accompanied by an impaired renal oxygenation, as the pronounced elevation of renal oxygen consumption is not met by a proportional increase in renal oxygen delivery. This information may provide new insights into renal pathophysiology as a basis for future strategies to prevent/treat AKI after liver transplantation.Trial registrationClinicalTrials.gov, NCT02455115. Registered on 23 April 2015.

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The use of terlipressin during living donor liver transplantation: Effects on systemic and splanchnic hemodynamics and renal function*

Abstract: Perioperative use of terlipressin abrogates the early postoperative decline in renal function of patients who have chronic liver disease and undergo liver transplantation without any detrimental effect on hepatosplanchnic gas exchange and lactate metabolism.

Cited by 64 publications

References 17 publications

Transfusion Rate for 500 Consecutive Liver Transplantations

Transfusion Rate for 500 Consecutive Liver Transplantations

Effect of Perioperative Terlipressin on Postoperative Renal Function in Patients Who Have Undergone Living Donor Liver Transplantation: A Meta-Analysis of Randomized Controlled Trials

Renal function and oxygenation are impaired early after liver transplantation despite hyperdynamic systemic circulation

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