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Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial.
Clin Transplant. 2017 08; 31(8)CT

Abstract

BACKGROUND AND AIM

Acute kidney injury (AKI) with liver transplantation (LT) is not uncommon. Impact of terlipressin infusion on AKI, hemodynamics, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) was studied.

METHODS

Patients (n=50) were randomized (NCT02059460, USA) into two equal groups: terlipressin vs Controls. Terlipressin (1-4 μg/kg/h) was administrated for 5 days. Intraoperative transesophageal Doppler for hemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV), and hepatic artery resistive index (HARI) were recorded. Plasma NGAL (pNGAL) was measured baseline, 2 and 24 hours postreperfusion.

RESULTS

Hepatitis C virus (HCV) was the main etiology. Age, sex, model of end-stage liver disease (MELD), and renal functions were comparable. Postoperative AKI incidence and NGAL concentrations were comparable (P>.05) between terlipressin and controls groups (44% vs 48% and 112.5±9 vs 93.1±8 ng/mL), respectively, but intraoperative NGAL in both groups increased significantly 2 hours postreperfusion (P<.05). The three NGAL readings were comparable (P>.05) between AKI (n=23) and non-AKI developers (n=27). Mean arterial blood pressure (MAP) was maintained in both groups with less systemic vascular resistance (SVR) fluctuations with terlipressin. Median norepinephrine consumption was lower in terlipressin vs controls (8 vs 12 mg; P=.04). The PPV and HARI were not affected by terlipressin at any stage (P>.05).

CONCLUSION

Postliver transplant AKI was not prevented by terlipressin use nor predicted by NGAL levels.

Authors+Show Affiliations

Department of Anaesthesia, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.Faculty of Medicine, Department of Anaesthesia, Menoufia University, Shebeen El-Kom, Egypt.Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.Department of Anaesthesia, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.Faculty of Medicine, Department of Anaesthesia, Menoufia University, Shebeen El-Kom, Egypt.Department of Anaesthesia, National Hepatology and Tropical Medicine Research Institute, Ministry of Health, Shebeen El-Kom, Egypt.Department of Anaesthesia, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28564127

Citation

Kandil, Mohamed A., et al. "Impact of Terlipressin Infusion During and After Live Donor Liver Transplantation On Incidence of Acute Kidney Injury and Neutrophil Gelatinase-associated Lipocalin Serum Levels: a Randomized Controlled Trial." Clinical Transplantation, vol. 31, no. 8, 2017.
Kandil MA, Abouelenain KM, Alsebaey A, et al. Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial. Clin Transplant. 2017;31(8).
Kandil, M. A., Abouelenain, K. M., Alsebaey, A., Rashed, H. S., Afifi, M. H., Mahmoud, M. A., & Yassen, K. A. (2017). Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial. Clinical Transplantation, 31(8). https://doi.org/10.1111/ctr.13019
Kandil MA, et al. Impact of Terlipressin Infusion During and After Live Donor Liver Transplantation On Incidence of Acute Kidney Injury and Neutrophil Gelatinase-associated Lipocalin Serum Levels: a Randomized Controlled Trial. Clin Transplant. 2017;31(8) PubMed PMID: 28564127.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial. AU - Kandil,Mohamed A, AU - Abouelenain,Khalid M, AU - Alsebaey,Ayman, AU - Rashed,Hanaa S, AU - Afifi,Mohamed H, AU - Mahmoud,Mohamed A, AU - Yassen,Khaled A, Y1 - 2017/06/25/ PY - 2017/05/26/accepted PY - 2017/6/1/pubmed PY - 2018/5/23/medline PY - 2017/6/1/entrez KW - acute kidney injury KW - cirrhosis KW - liver transplantation KW - neutrophil gelatinase-associated lipocalin KW - terlipressin JF - Clinical transplantation JO - Clin Transplant VL - 31 IS - 8 N2 - BACKGROUND AND AIM: Acute kidney injury (AKI) with liver transplantation (LT) is not uncommon. Impact of terlipressin infusion on AKI, hemodynamics, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) was studied. METHODS: Patients (n=50) were randomized (NCT02059460, USA) into two equal groups: terlipressin vs Controls. Terlipressin (1-4 μg/kg/h) was administrated for 5 days. Intraoperative transesophageal Doppler for hemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV), and hepatic artery resistive index (HARI) were recorded. Plasma NGAL (pNGAL) was measured baseline, 2 and 24 hours postreperfusion. RESULTS: Hepatitis C virus (HCV) was the main etiology. Age, sex, model of end-stage liver disease (MELD), and renal functions were comparable. Postoperative AKI incidence and NGAL concentrations were comparable (P>.05) between terlipressin and controls groups (44% vs 48% and 112.5±9 vs 93.1±8 ng/mL), respectively, but intraoperative NGAL in both groups increased significantly 2 hours postreperfusion (P<.05). The three NGAL readings were comparable (P>.05) between AKI (n=23) and non-AKI developers (n=27). Mean arterial blood pressure (MAP) was maintained in both groups with less systemic vascular resistance (SVR) fluctuations with terlipressin. Median norepinephrine consumption was lower in terlipressin vs controls (8 vs 12 mg; P=.04). The PPV and HARI were not affected by terlipressin at any stage (P>.05). CONCLUSION: Postliver transplant AKI was not prevented by terlipressin use nor predicted by NGAL levels. SN - 1399-0012 UR - https://www.unboundmedicine.com/medline/citation/28564127/Impact_of_terlipressin_infusion_during_and_after_live_donor_liver_transplantation_on_incidence_of_acute_kidney_injury_and_neutrophil_gelatinase_associated_lipocalin_serum_levels:_A_randomized_controlled_trial_ L2 - https://doi.org/10.1111/ctr.13019 DB - PRIME DP - Unbound Medicine ER -