title: The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.
authors.forename: Nagwa
authors.initials: N
authors.lastname: Ibrahim
authors.affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hasanin
authors.affiliation: Department of Anaesthesia, Faculty of Medicine, Menoufiya University, Menufiya, Egypt.
authors.forename: Sabry Abd
authors.initials: SA
authors.lastname: Allah
authors.affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Sayed
authors.affiliation: Department of Anaesthesia, Faculty of Medicine, Menoufiya University, Menufiya, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Afifi
authors.affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: Yassen
authors.affiliation: Public Health and Community Medicine Department, Liver Institute, Menoufiya University, Sheben El-Kom City, Menufiya, Egypt.
authors.forename: Wesam
authors.initials: W
authors.lastname: Saber
authors.affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.
authors.forename: Magdy
authors.initials: M
authors.lastname: Khalil
keywords: Haemodynamics; liver; renal; terlipressin; transplantation
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