Double Blind Randomized Controlled Trial of the Routine Peri-operative Use of Terlipressin in Adult Living Donor Liver Transplantation.
Reddy MS, Kaliamoorthy I, et al.Liver Transplantation 2017 [record in progress].
Aims
To evaluate the haemodynamic effects, clinical benefits and safety of peri-operative terlipressin (Tp) infusion in adult living donor liver transplantation (LDLT).
Interventions
Participants were randomized after a complete laparotomy to receive either an initial intravenous bolus of Tp followed by continuous infusion of Tp for 72 hours (Tp group), versus an initial saline bolus followed by saline infusion for 72 hours (Placebo group).
Participants
41 adults aged >18 years undergoing their first LDLT.
Outcomes
The primary outcome measured was portal pressure after arterial anastomosis. Secondary outcomes included vasopressor requirement, ascites, blood gases, blood loss, fluid and blood product requirement, intra-operative and daily urine output, drain output, blood investigations, doppler indices, complications, need for intervention, drug related adverse effects and need for termination of trial medication.
Follow-up
Not described
CET Conclusions
This is a well conducted, double-blind, randomised controlled trial. It was small in size (41 patients), and did not show a difference in the primary outcome of portal pressure after perfusion. There was, however, a reduction in post-operative ascetic drain output, and reduced hospital stay in the Terlipression group. This must be weighed against the concerning findings of increased intra-operative lactate and bradycardia when Terlipressin was used. In conclusion, Terlipressin is not recommended in live donor liver transplant recipients for this reason.
Data analysis
Strict intention-to-treat analysis
Trial registration
Clinical Trial Registry-India CTRI/2013/10/004072