Aprotinin reduces vasoactive medication use during adult liver transplantation.
OBJECTIVE
To determine whether aprotinin use during adult liver transplantation results in an improvement in hemodynamic stability.


METHODS
Review of data collected during a prospective, randomized, double-blind trial.


METHODS
Liver transplantation program in a tertiary referral institution.


METHODS
63 adult patients undergoing orthotopic liver transplantation (OLT).


METHODS
Patients were randomized to receive either aprotinin (1,000,000 KIU loading dose, followed by an infusion of 250,000 KIU/hr) for the duration of the surgery or a placebo infusion (normal saline).


METHODS
Hemodynamic parameters (mean systemic blood pressure, cardiac output, systemic vascular resistance, mean pulmonary artery (PA) pressure, and PA occlusion pressure) were compared at set time points during the procedure. The use of vasoactive medications during and after the reperfusion period was compared.


RESULTS
There were no significant differences in any of the measured hemodynamic parameters at any time point. Vasoactive infusions were used in 1 of 33 patients in the aprotinin group and in 6 of 30 patients in the control group (p < 0.05). Bolus doses of pressor medications during the recirculation period did not differ between groups.


CONCLUSIONS
Aprotinin infusion during adult liver transplantation results in less requirement for vasoactive intervention.
Findlay
James Y
JY
Department of Anesthesiology, Mayo Foundation, Rochester, MN 55905, USA. findlay.james@mayo.edu
Kufner
Ronald P
RP
D007611:Aprotinin / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002122:Calcium Chloride / Q000008:administration & dosage / Q000494:pharmacology; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007432:Intraoperative Period; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000008:administration & dosage / Q000494:pharmacology; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000187:drug effects / Q000502:physiology; D015427:Reperfusion Injury / Q000517:prevention & control; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use*
D006490:Hemostatics; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D007611:Aprotinin; D002122:Calcium Chloride; D004837:Epinephrine