Imai Shunichi, Shinoda Masahiro, Obara Hideaki, Kitago Minoru, Hibi Taizo, Abe Yuta, Yagi Hiroshi, Matsubara Kentaro, Higashi Hisanobu, Itano Osamu, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Ann Transplant. 2018 Jan 9;23:25-33. doi: 10.12659/aot.905817.
BACKGROUND Tolvaptan, an antagonist of the vasopressin V2 receptor is a novel oral diuretic that promotes water excretion selectively. We have used furosemide as a primary diuretic and added human atrial natriuretic peptide (hANP) if necessary for fluid management postoperatively in living-donor liver transplantation (LDLT) recipients. Recently we introduced tolvaptan and used both tolvaptan and furosemide as primary diuretics. MATERIAL AND METHODS Clinical outcomes were compared between LDLT recipients whose postoperative fluid management was performed before (control group, n=10) and after (tolvaptan group, n=16) introduction of tolvaptan. RESULTS Preoperative and intraoperative demographic data did not differ significantly between the groups except for the period of post-surgical follow-up and total ischemic time. Urine volume was 1,242±692, 2,240±1307, and 2,268±1262 mL on postoperative day 1, 3, and 7, respectively, in the tolvaptan group. These volumes did not significantly differ from those in control group (1,027±462, 1,788±909, and 2,057±1216 mL on day 1, 3, and 7 postoperatively, respectively). Body weight gain and fluid volume from abdominal drainage tubes postoperatively did not differ significantly between groups. The time from hANP initiation to discontinuation and the time to removal of central vein catheters were significantly reduced in tolvaptan-treated patients. No severe side effects directly related to tolvaptan were observed. The survival rate at month 6 was 90.0% in control patients versus 93.8% in tolvaptan-treated patients. CONCLUSIONS The outcomes of this investigation indicate that tolvaptan in combination with furosemide provides an adequate diuretic for fluid management subsequent to LDLT without causing adverse effects.
背景 托伐普坦是一种血管加压素V2受体拮抗剂，是一种新型口服利尿剂，可选择性促进水排泄。在活体肝移植（LDLT）受者术后的液体管理中，我们一直将呋塞米作为主要利尿剂，并在必要时添加人心房利钠肽（hANP）。最近，我们引入了托伐普坦，并将托伐普坦和呋塞米都用作主要利尿剂。材料与方法 比较了在引入托伐普坦之前（对照组，n = 10）和之后（托伐普坦组，n = 16）进行术后液体管理的LDLT受者的临床结果。结果 除手术后续随访时间和总缺血时间外，两组术前和术中的人口统计学数据无显著差异。托伐普坦组术后第1、3和7天的尿量分别为1242±692、2240±1307和2268±1262 mL。这些尿量与对照组（术后第1、3和7天分别为1027±462、1788±909和2057±1216 mL）无显著差异。术后体重增加和腹腔引流管的液体量在两组之间无显著差异。托伐普坦治疗的患者从开始使用hANP到停用的时间以及拔除中心静脉导管的时间显著缩短。未观察到与托伐普坦直接相关的严重副作用。对照组患者6个月时的生存率为90.0%，而托伐普坦治疗患者为93.8%。结论 本研究结果表明，托伐普坦与呋塞米联合使用可为LDLT术后的液体管理提供足够的利尿作用，且不会引起不良反应。
