预防性围手术期特利加压素治疗对活体肝移植受者急性肾损伤的预防作用：一项系统评价和荟萃分析。
Prophylactic Perioperative Terlipressin Therapy for Preventing Acute Kidney Injury in Living Donor Liver Transplant Recipients: A Systematic Review and Meta-Analysis.
作者信息
Kulkarni Anand V, Kumar Karan, Candia Roberto, Arab Juan P, Tevethia Harsh V, Premkumar Madhumita, Sharma Mithun, Menon Balachandandran, Rao Guduru V, Reddy Nageshwar D, Rao Nagaraja P
机构信息
Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Department of Hepatology, Pacific Institute of Medical Sciences, Udaipur, India.
出版信息
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):417-427. doi: 10.1016/j.jceh.2021.06.019. Epub 2021 Jun 25.
BACKGROUND
Acute kidney injury (AKI) is common in the perioperative transplant period and is associated with poor outcomes. Few studies reported a reduction in AKI incidence with terlipressin therapy by counteracting the hemodynamic alterations occurring during liver transplantation. However, the effect of terlipressin on posttransplant outcomes has not been systematically reviewed.
METHODS
A comprehensive search of electronic databases was performed. Studies reporting the use of terlipressin in the perioperative period of living donor liver transplantation were included. We expressed the dichotomous outcomes as risk ratio (RR, 95% confidence interval [CI]) using the random effects model. The primary aim was to assess the posttransplant risk of AKI. The secondary aims were to assess the need for renal replacement therapy (RRT), vasopressors, effect on hemodynamics, blood loss during surgery, hospital and intensive care unit (ICU) stay, and in-hospital mortality.
RESULTS
A total of nine studies reporting 711 patients (309 patients in the terlipressin group and 402 in the control group) were included for analysis. Terlipressin was administered for a mean duration of 53.44 ± 28.61 h postsurgery. The risk of AKI was lower with terlipressin (0.6 [95% CI, 0.44-0.8]; = 0.001). However, on sensitivity analysis including only four randomized controlled trials (I = 0; = 0.54), the risk of AKI was similar in both the groups (0.7 [0.43-1.09]; = 0.11). The need for RRT was similar in both the groups (0.75 [0.35-1.56]; = 0.44). Terlipressin therapy reduced the need for another vasopressor (0.34 [0.25-0.47]; < 0.001) with a concomitant rise in mean arterial pressure and systemic vascular resistance by 3.2 mm Hg (1.64-4.7; < 0.001) and 77.64 dyne cm.sec (21.27-134; = 0.007), respectively. Blood loss, duration of hospital/ICU stay, and mortality were similar in both groups.
CONCLUSIONS
Perioperative terlipressin therapy has no clinically relevant benefit.
背景
急性肾损伤（AKI）在围手术期移植阶段很常见，且与不良预后相关。很少有研究报告特利加压素治疗可通过抵消肝移植期间发生的血流动力学改变来降低AKI发生率。然而，特利加压素对移植后结局的影响尚未得到系统评价。
方法
对电子数据库进行全面检索。纳入报告在活体肝移植围手术期使用特利加压素的研究。我们使用随机效应模型将二分结局表示为风险比（RR，95%置信区间[CI]）。主要目的是评估移植后发生AKI的风险。次要目的是评估肾脏替代治疗（RRT）、血管升压药的需求、对血流动力学的影响、手术期间的失血量、住院和重症监护病房（ICU）住院时间以及住院死亡率。
结果
共纳入9项研究，涉及711例患者（特利加压素组309例，对照组402例）进行分析。特利加压素术后平均给药时间为53.44±28.61小时。特利加压素治疗组发生AKI的风险较低（0.6[95%CI，0.44 - 0.8]；P = 0.001）。然而，在仅包括4项随机对照试验的敏感性分析中（I² = 0；P = 0.54），两组发生AKI的风险相似（0.7[0.43 - 1.09]；P = 0.11）。两组对RRT的需求相似（0.75[0.35 - 1.56]；P = 0.44）。特利加压素治疗减少了对另一种血管升压药的需求（0.34[0.25 - 0.47]；P < 0.001），同时平均动脉压和全身血管阻力分别升高3.2 mmHg（1.64 - 4.7；P < 0.001）和77.64达因·厘米·秒（21.27 - 134；P = 0.007）。两组的失血量、住院/ICU住院时间和死亡率相似。
结论
围手术期特利加压素治疗无临床相关益处。
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