Perioperative Assessment of Terlipressin Infusion during Living Donor Liver Transplantation

Hong, Sang Hyun; Lee, J. M.; Choi, Jong Ho; Chung, Hyun Sik; Park, J. H.; Park, Chul Soo

doi:10.1177/147323001204000123

Cited by 19 publications

(51 citation statements)

References 28 publications

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“…There were no significant differences in the age and sex of patients between the 2 groups in all the studies. In 1 study, the mean MELD score was lower in the terlipressin group than in the control group, but this was not statistically significant [14].…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 76%

“…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%

“…In one study's [14] terlipressin group, the terlipressin infusion started at a dosage of 1 mg/kg per hour and was then titrated at a dose of 1e4 mg/kg per hour to maintain a MAP of >65 mm Hg; it was limited to 60 min after reperfusion of the portal vein flow. Dopamine, norepinephrine, and/or dobutamine was administered to maintain a MAP of >65 mm Hg in the control.…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

“…In 1 study, the terlipressin infusion was started at a dose of 1.4 mg/kg/hour and then was titrated at a dose of 1e4 mg/kg/hour until 60 min after reperfusion of the portal vein flow[14]. A more aggressive dosage of terlipressin and longer infusion period are needed to improve the renal function postoperatively.Mukhtar et al suggested measuring baseline vital signs before terlipressin is administered.Fayed et al suggested that these measurements be performed at the "baseline point," and Hong et al recommended that the measurements be performed immediately after anesthetic preparation.…”

mentioning

confidence: 99%

See 3 more Smart Citations

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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Section: Study Characteristics and Patient Populationsmentioning

confidence: 76%

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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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“…Efedrin bolus olarak 5-20 mg i.v. dozlarında akut hipotansiyonda kullanılabilir (2,(30)(31)(32)(33)(34). Greft disfonksiyonunda SVR'yi yükseltebilmek veya vazopresör dozlarını azaltabilmek mümkün olamayabilir.…”

Section: Kardiyovasküler Sorunlar Ve Hemodinamik Yönetimunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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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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Perioperative Assessment of Terlipressin Infusion during Living Donor Liver Transplantation

Abstract: Terlipressin infusion improved low SVRI and PVRI during LDLT and may have contributed to better renal function and shorter ICU stays.

Cited by 19 publications

References 28 publications

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

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

Critical Care Management after Adult Liver Transplantation

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

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