Effect of Perioperative Terlipressin on Postoperative Renal Function in Patients Who Have Undergone Living Donor Liver Transplantation: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Recent studies have shown the efficacy of terlipressin on postoperative renal function in patients who have undergone living donor liver transplantation (LDLT).

Objectives: To evaluate the effect of perioperative terlipressin on postoperative renal function in patients who have undergone LDLT and to analyze the hemodynamic data during transplantation surgery.

Study design: A meta-analysis.

Methods: We assessed the postoperative peak serum creatinine level and changes in the hemodynamic data (e.g. the mean arterial pressure, heart rate, and systemic vascular resistance). We collected randomized controlled trials from PubMed, EMBASE Drugs and Pharmacology, Cochrane Controlled Trials Register, and Cochrane Database on Systematic Reviews. Analysis was conducted using RevMan 5.2. Data from each trial were pooled and weighted by their mean differences and corresponding 95% confidence intervals (CI). A heterogeneity assessment was performed.

Results: Three trials (151 patients) were included. The difference in the mean (95% CI) peak serum creatinine (mg/dL) levels postoperatively was not significant between the intervention and control groups (weighted mean difference [WMD]: -0.27; CI: -0.55-0.01; P = .06). Terlipressin significantly decreased heart rate during the anhepatic phase (WMD: -6.58; 95% CI: -8.85 to -4.31; P < .00001) with a low heterogeneity (I(2) = 41%) and significantly decreased heart rate during the neohepatic phase (WMD: -9.82; 95% CI: -11.96 to -7.68; P < .00001), although the heterogeneity was high (I(2) > 50%).

Conclusions: An intravenous infusion of terlipressin perioperatively for LDLT has no effect on the creatinine values postoperatively. Larger randomized controlled trials on terlipressin infusions during liver transplantation are needed.