title: Double-blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation.
abstract: Perioperative terlipressin (Tp) during living donor liver transplantation (LDLT) has been shown to reduce intraoperative portal pressures and improve renal function. Its role and safety profile have never been evaluated in a double-blind randomized controlled trial (RCT). The aim was to evaluate the hemodynamic effects, clinical benefits, and safety of perioperative Tp infusion in adult LDLT. This was a single-center double-blind RCT. Consenting adults with chronic liver disease and low risk of posttransplant renal dysfunction undergoing their first LDLT were randomized. The study group (terlipressin group [TpG]) received an initial bolus of Tp during surgery followed by a Tp infusion for 72 hours in the postoperative period. The placebo group (PbG) received a saline infusion. The primary endpoint was portal pressure after arterial reperfusion. Multiple intraoperative and postoperative variables served as secondary endpoints. A total of 41 patients were enrolled in the trial (TpG, 21; PbG, 20). There were no significant differences in intraoperative portal pressures, blood loss, fluid requirement, vasopressor requirement, or urine output. Peak intraoperative and end of surgery lactate levels were significantly higher in the Tp group. There was no difference in postoperative liver function tests. Incidence of acute kidney injury as assessed by Risk, Injury, Failure, Loss, and End-Stage Kidney Disease criteria was lower in the Tp group (27% versus 60%; P = 0.04). The TpG had less postoperative ascites, a lower need for percutaneous interventions, and a shorter hospital stay. Incidence of bradycardia requiring pharmacological intervention and withdrawal from study was significantly higher in the TpG. In conclusion, this study has not demonstrated a reduction in postreperfusion portal pressure with Tp. However, Tp infusion reduced postoperative ascitic drain output resulting in less frequent percutaneous interventions and reduced hospital stay. Intraoperative hyperlactatemia and symptomatic bradycardia are major concerns. Its use should be restricted to patients with high-volume ascites, and it needs close monitoring during drug infusion. Liver Transplantation 23 1007-1014 2017 AASLD.
authors.affiliation: Institute of Liver Disease and Transplantation, Global Hospital, Chennai, India.|National Foundation for Liver Research, Chennai, India.
authors.forename: Mettu Srinivas
authors.initials: MS
authors.lastname: Reddy
authors.affiliation: Department of Liver Anesthesia and Intensive Care, Global Hospital, Chennai, India.
authors.forename: Ilankumaran
authors.initials: I
authors.lastname: Kaliamoorthy
authors.affiliation: Department of Liver Anesthesia and Intensive Care, Global Hospital, Chennai, India.
authors.forename: Akila
authors.initials: A
authors.lastname: Rajakumar
authors.affiliation: Department of Liver Anesthesia and Intensive Care, Global Hospital, Chennai, India.
authors.forename: Selvakumar
authors.initials: S
authors.lastname: Malleeshwaran
authors.affiliation: Department of Liver Anesthesia and Intensive Care, Global Hospital, Chennai, India.
authors.forename: Ellango
authors.initials: E
authors.lastname: Appuswamy
authors.affiliation: Institute of Liver Disease and Transplantation, Global Hospital, Chennai, India.
authors.forename: Sukanya
authors.initials: S
authors.lastname: Lakshmi
authors.affiliation: Institute of Liver Disease and Transplantation, Global Hospital, Chennai, India.
authors.forename: Joy
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Institute of Liver Disease and Transplantation, Global Hospital, Chennai, India.|National Foundation for Liver Research, Chennai, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D001201:Ascites / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D001919:Bradycardia / Q000139:chemically induced / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007902:Length of Stay / Q000706:statistics & numerical data; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D017082:Portal Pressure / Q000187:drug effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin