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Diagnostic Accuracy of ODM+ Unpicks Terlipressin’s Lack of Renal Protection

Acute kidney injury (AKI) is not uncommon with liver transplantation. A newly published Egyptian study (abstract here) assesses the impact of a Terlipressin infusion on AKI, haemodynamics and plasma concentrations of neutrophil gelatinise-associated lipocalin (a renal marker).

Background

Terlipressin has been used to prevent AKI following liver transplantation. The investigators set out to study its impact on key physiological parameters.

“Terlipressin (triglycyl-lysine vasopressin) is a long-acting vasopressin analog; it is rapidly metabolized by endopeptidases to form the vasoactive lysine vasopressin.

“Terlipressin selectively causes splanchnic and extra renal vasoconstriction, which helps reduce splanchnic blood flow and portal pressure. One of the main indications for Terlipressin is the treatment of acute variceal bleeding and hepatorenal syndrome. A continuous infusion of low-dose Terlipressin had been shown to be effective in reversing sepsis-induced arterial hypotension.”

The study

Researchers assigned 25 patients to receive Terlipressin, where haemodynamics were assessed by ODM+. A further 25 patients were allocated to a standard care group. In the treatment group, Terlipressin was infused until the fourth post-operative day. Monitoring using ODM+ occurred until the patient was weaned off the ventilator, usually by the end of post-op day 1. In both groups, noradrenaline was infused if MAP was <60 mm Hg following adequate volume resuscitation. Incremental boluses of ephedrine were used to restore haemodynamic stability during the postreperfusion hypotension. IV furosemide boluses were used when urine output was <0.5mL/kg/h and the patient was not hypovolemic. Crystalloids were given as a background infusion of ringers acetate at 6 mL/kg/h. Additional fluids, crystalloid and colloid (Albumin 5%) were infused, guided by ODM+ (referred to as TED in the paper – TransEsophageal Doppler).

The study showed that “Terlipressin infusion did not provide renal protection for the recipients in this randomized controlled trial. TED monitoring showed a reduction in intraoperative SVR fluctuations with Terlipressin infusion, which helped to maintain mean arterial blood pressure at less catecholamines demand.

The researchers stated; “Terlipressin did not affect the graft hepatic circulation in this study. Transesophageal Doppler monitoring was of help to diagnose hemodynamic changes and monitor the effect Terlipressin and noradrenaline infusion.”

Deltex comments

For Deltex Medical, Technical and Clinical Manager, Ellie Philpott commented; “This is another piece of supportive evidence for the use of ODM+. Not only has it been used here to monitor and guide fluid management, but its diagnostic accuracy has enabled the researchers to isolate the physiological impact of the drug.”