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

BACKGROUND AND AIMS

Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters.

METHODS

After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25) or terlipressin group (n = 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0-4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index <2600 dyne.s/cm5(/) m2 till day 4. Nor-epinephrine was used as appropriate. Haemodynamic and transoesophageal Doppler parameters (intraoperative), renal function, peak portal vein blood flow velocity (PPV), hepatic artery resistive index (HARI), urine output (UOP), liver enzymes, catecholamine support were compared intra-operatively and 4 days post-operatively. Desflurane administration was guided with entropy.

RESULTS

Terlipressin maintained better MAP and SVR (P < 0.01) during reperfusion versus controls (66.5 ± 16.08 vs. 47.7 ± 4.7 mmHg and 687.7 ± 189.7 vs. 425.0 ± 26.0 dyn.s/cm(5)), respectively. Nor epinephrine was used in 5 out of 25 versus 20 in controls. Urea, creatinine and UOP were significantly better with terlipressin. PPV was reduced with terlipressin post-reperfusion versus controls (44.8 ± 5.2 vs. 53.8 ± 3.9 ml/s, respectively, P < 0.01) without affecting HARI (0.63 ± 0.06 vs. 0.64 ± 0.05, respectively, P > 0.05) and was sustained post-operatively.

CONCLUSION

Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.