Perioperative splanchnic vasoregulation with terlipressin in patients undergoing major liver resection: a randomized controlled trial

Abstract

Introduction: Extensive liver resection leads to an increase in portal pressure. This is potentially associated with impaired liver regeneration and postoperative complications. Terlipressin, a splanchnic vasoconstrictor, decreases portal hypertension and improves renal function in patients with hepatorenal syndrome. Our hypothesis was that perioperative administration of terlipressin could prevent postoperative complications and protect kidney function. Method: A randomized double-blind placebo-controlled trial was performed, including patients undergoing elective major liver resection. In the intervention group, terlipressin was administered prior to resection and repeated every eight hours for a period of five days. The primary outcome was the incidence of a composite endpoint, consisting of the following postoperative complications: liver failure, ascites, bile leakage, intraabdominal abscess and operative mortality after 30 days. A secondary endpoint was postoperative kidney function. Results: A total of 150 patients were included in the study. Baseline criteria were similar between the two groups. There was no difference in the occurrence of the composite endpoint in the intervention group compared to the control group (22.6% versus 24.1%, p=>0.99, Fisher exact test). In patients with preexisting liver disease, kidney function was improved in the postoperative phase if terlipressin was administered. In this population, the change in glomerular filtration rate (GFR) was statistically different after terlipressin administration compared to the control group (delta GFR +2.8 vs. -3.93 ml/min/1.73m2 respectively, p=0.031, student's t-test). Conclusions: Administration of terlipressin does not prevent liver specific complications after major liver resection. However, terlipressin has a protective effect on renal function in patients with preexisting liver disease.