Abstract
Norepinephrine (NE) is often administered during the perioperative period of liver transplantation to address hemodynamic instability and to improve organ perfusion and oxygen supply. However, its role and safety profile have yet to be evaluated in pediatric living donor liver transplantation (LDLT). We hypothesized that intraoperative NE infusion might affect pediatric LDLT outcomes. A retrospective study of 430 pediatric patients (median [interquartile range] age, 7 [6.10] months; 189 [43.9%] female) receiving LDLT between 2014 and 2016 at Renji Hospital was conducted. We evaluated patient survival among recipients who received intraoperative NE infusion (NE group, 85 recipients) and those that did not (non-NE group, 345 recipients). The number of children aged over 24 months and weighing more than 10 kg in NE group was more than that in non-NE group. And children in NE group had longer operative time, longer anhepatic phase time and more fluid infusion. After multivariate regression analysis and propensity score regression adjusting for confounding factors to determine the influence of intraoperative NE infusion on patient survival, the NE group had a 169% more probability of dying. Although there was no difference in mean arterial pressure changes relative to the baseline between the two groups, we did observe increased heart rates in NE group compared with those of the non-NE group at anhepatic phase (P=0.025), neohepatic phase (P=0.012) and operation end phase (P=0.017) of the operation. In conclusion, intraoperative NE infusion was associated with a poorer prognosis for pediatric LDLT recipients. Therefore, we recommend the application of NE during pediatric LDLT should be carefully re-considered.
Highlights
Living donor liver transplantation (LDLT) was first introduced in China in June 1997 as a life-saving treatment for children with end-stage liver disease (ESLD) due to the consistent shortage of donor organs
We reported our experience with 430 pediatric living donor liver transplantation (LDLT) recipients at a high-volume hospital and demonstrated that intraoperative NE infusion was significantly associated with mortality within 6-month after LT
In this retrospective cohort study, our results have shown that intraoperative NE infusion was associated with poor prognosis for pediatric LDLT recipients, implying that NE might not be the best choice for circulatory support during pediatric LDLT
Summary
Living donor liver transplantation (LDLT) was first introduced in China in June 1997 as a life-saving treatment for children with end-stage liver disease (ESLD) due to the consistent shortage of donor organs. LT (Junge et al, 2018) For these patients with underlying CCM, more attention should be paid to the selection and application of cardiovascular active drugs during pediatric LDLT, so as to avoid increasing cardiac stress and aggravating cardiac injury, and to improve outcomes. As one of the powerful vasoconstrictors released by sympathetic nerve endings and the adrenal medulla, NE is characterized by a-adrenergic agonistic activity in addition to a weak b-adrenergic agonistic activity It is the first-line agent to maintain end-organ perfusion pressure, especially in critically ill patients with low systemic vascular resistance. Perioperative variables included in the analysis were sex, age, body weight (BW), graft-to-recipient weight ratio (GRWR) measurement, diagnosis of primary diseases, Kasai procedure, Pediatric End-Stage Liver Disease (PELD) score, donor/recipient ABO compatibility, preoperative white blood cell (WBC) and hemoglobin (Hb) levels, operative time, duration of anhepatic phase, amount of blood loss, amount of intraoperative fluid, and red blood cell infusion. All analyses were performed using the SPSS 25.0 statistical package (IBM, Inc., Chicago, IL)
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