Prophylactic Perioperative Terlipressin Therapy for Preventing Acute Kidney Injury in Living Donor Liver Transplant Recipients: A Systematic Review and Meta-Analysis

Abstract

Acute kidney injury (AKI) is common in the perioperative transplant period and is associated with poor outcomes. Few studies reported a reduction in AKI incidence with terlipressin therapy by counteracting the hemodynamic alterations occurring during liver transplantation. However, the effect of terlipressin on posttransplant outcomes has not been systematically reviewed. A comprehensive search of electronic databases was performed. Studies reporting the use of terlipressin in the perioperative period of living donor liver transplantationwere included. We expressed the dichotomous outcomes as risk ratio (RR, 95% confidence interval [CI]) using the random effects model. The primary aim was to assess the posttransplant risk of AKI. The secondary aims were to assess the need for renal replacement therapy (RRT), vasopressors, effect on hemodynamics, blood loss during surgery, hospital and intensive care unit (ICU) stay, and in-hospital mortality. A total of nine studies reporting 711 patients (309 patients in the terlipressin group and 402 in the control group) were included for analysis. Terlipressin was administered for a mean duration of 53.44±28.61h postsurgery. The risk of AKI was lower with terlipressin (0.6 [95% CI, 0.44-0.8]; P=0.001). However, on sensitivity analysis including only four randomized controlled trials (I2= 0; P= 0.54), the risk of AKI was similar in both the groups (0.7 [0.43-1.09]; P=0.11). The need for RRT was similar in both the groups (0.75 [0.35-1.56]; P=0.44). Terlipressin therapy reduced the need for another vasopressor (0.34 [0.25-0.47]; P<0.001) with a concomitant rise in mean arterial pressure and systemic vascular resistance by 3.2mm Hg (1.64-4.7; P<0.001) and 77.64dynecm-1.sec-5 (21.27-134; P=0.007), respectively. Blood loss, duration of hospital/ICU stay, and mortality were similar in both groups. Perioperative terlipressin therapy has no clinically relevant benefit.