cardiovascular-agents and Liver-Failure

End-stage liver failure is currently treatable both by dialysis and by liver transplantation, but this does not detract from its being a complex pathophysiological and pharmacological entity. More patients survive after transplant because of the impressive developments that enabled improved liver preservation, anesthesia and surgical techniques, as well as immunosuppressive drug therapy. Because of its multifaceted metabolism, liver failure can nevertheless cause a complex of pathophysiological conditions and, as such, poses a challenge for surgeons and anesthesiologists alike, not only before surgery but during transplantation as well. Obviating these problems frequently requires the use of adjunct drugs before, during and after liver transplantation, and these medications must be carefully balanced with each other while being alert to the avoidance of negative side effects. Hepatorenal syndrome and massive bleeding are the two main grave phenomena that characterize these patients before and during liver transplant, and this article will provide an overview of the adjunct drugs that are used to circumvent them perioperatively. Specifically, it details the drugs that are used to preserve and improve the already precarious hemodynamic conditions (e.g, by vasopressors, vasodilators, and beta blockers), as well as diuretics and hepato-protective drugs (e.g, furosemide, mannitol), antifibrinolytics (including the new recombinant activated Factor VII) and immunosuppressive drugs. Their doses and the ongoing debate on their concomitant use are reported as well.

Topics: Adjuvants, Immunologic; Antifibrinolytic Agents; Cardiovascular Agents; Diuretics; Hepatorenal Syndrome; Humans; Immunosuppressive Agents; Liver Failure; Liver Transplantation

: Major hepatectomy (MH) can lead to an increasing portal vein pressure (PVP) and to lesions of the hepatic parenchyma. Several reports have assessed the deleterious effect of a high posthepatectomy PVP on the postoperative course of MH. Thus, several surgical modalities of portal inflow modulation (PIM) have been described. As for pharmacological modalities, experimental studies showed a potential efficiency of Somatostatin to reduce PVP and flow. To our knowledge, no previous clinical reports of PIM using somatostatin are available. Herein, we report the results of PIM using somatostatin in 10 patients who underwent MH with post-hepatectomy PVP > 20 mmHg. Our results suggest Somatostatin could be considered as an efficient reversible PIM when PVP decrease is above 2.5 mmHg.

Topics: Cardiovascular Agents; Hepatectomy; Humans; Liver Failure; Pilot Projects; Portal Pressure; Portal Vein; Postoperative Complications; Regional Blood Flow; Somatostatin

To analyze how graft-weight-to-bodyweight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters.. We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio ≤ 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters.. Patients in the large-graft-for-size group (>4%) received more colloid solution (57.7 ± 20.1 mL/kg vs 45.1 ± 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 ± 0.6 mg/kg vs 0.4 ± 0.7 mg/kg; P = .018). They had lower mean pH (7.1 ± 0.1 vs 7.2 ± 0.1; P = .004) and PO2 (115.4 ± 44.6 mm Hg vs 147.6 ± 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 ± 96.9 mg/dL vs 262.8 ± 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 ± 0.7°C vs 35.2 ± 0.6°C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 ± 24.3 mL/kg vs 18.8 ± 21.8 mL/kg; P = .013) and neohepatic (17.7 ± 20.4 mL/kg vs 10.3 ± 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 ± 17.6 mL/kg vs 6.2 ± 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intraoperatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05).. High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.

Topics: Adolescent; Age Factors; Biomarkers; Blood Transfusion; Body Weight; Cardiovascular Agents; Child; Child, Preschool; Female; Graft Rejection; Graft Survival; Hemodynamics; Hospital Mortality; Humans; Infant; Liver; Liver Failure; Liver Transplantation; Male; Organ Size; Patient Selection; Primary Graft Dysfunction; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome