title: The use of terlipressin during living donor liver transplantation: Effects on systemic and splanchnic hemodynamics and renal function.
abstract: OBJECTIVE
  To assess the effect of the intraoperative use of terlipressin on splanchnic hemodynamics and postoperative renal function in patients undergoing liver transplantation.
  
  
  METHODS
  Open-label, prospective, randomized study.
  
  
  METHODS
  Single-center study.
  
  
  METHODS
  Thirty patients who underwent elective, living-donor liver transplantation with portal pressure >20 mm Hg.
  
  
  METHODS
  Patients were assigned randomly to one of two equal groups. The control group received saline, whereas the treatment group (TP group) received an initial bolus dose of terlipressin (1 mg over 30 mins) followed immediately by a continuous infusion of 2 μg·kg(-1)·h(-1) for 48 hrs.
  
  
  RESULTS
  Portal pressure and gas exchange (radial artery, portal vein, and hepatic vein, blood gas analyses, and lactate concentration) were assessed at baseline (after ligation of the hepatic artery) and 2 hrs after drug administration. Systemic hemodynamic data and calculated tissue oxygenation parameters were compared throughout the procedure. Renal function was assessed by measurement of serum cystatin C after induction of anesthesia and on the first 2 days postoperatively. After the infusion of terlipressin, portal venous pressure decreased significantly from 26.3 ± 3.3 to 21.3 ± 3.6 mm Hg (p < .001). The mean arterial pressure and systemic vascular resistance were significantly higher in the TP group than in the control group, whereas heart rate and cardiac index were comparable between the groups. Portal and hepatic base excess, and the level of serum lactate, did not differ between the two groups. The serum levels of both cystatin C and creatinine were significantly higher in the control group than in the TP group on postoperative day 2.
  
  
  CONCLUSIONS
  Perioperative use of terlipressin abrogates the early postoperative decline in renal function of patients who have chronic liver disease and undergo liver transplantation without any detrimental effect on hepatosplanchnic gas exchange and lactate metabolism.
authors.affiliation: Department of Anesthesia and Intensive Care, Cairo University, Cairo, Egypt. ahmed3m2003@yahoo.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mukhtar
authors.forename: Maged
authors.initials: M
authors.lastname: Salah
authors.forename: Fawzia
authors.initials: F
authors.lastname: Aboulfetouh
authors.forename: Gihan
authors.initials: G
authors.lastname: Obayah
authors.forename: Maha
authors.initials: M
authors.lastname: Samy
authors.forename: Azza
authors.initials: A
authors.lastname: Hassanien
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bahaa
authors.forename: Amr
authors.initials: A
authors.lastname: Abdelaal
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fathy
authors.forename: Hany
authors.initials: H
authors.lastname: Saeed
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rady
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mostafa
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Meteini
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D014655:Vascular Resistance; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin