Effectiveness of terlipressin for prevention of complications after major liver resection - A randomized placebo-controlled trial.

Autor:	Kohler A; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland., Perrodin S; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland., De Gottardi A; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland., Candinas D; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland., Beldi G; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: guido.beldi@insel.ch.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2020 Jun; Vol. 22 (6), pp. 884-891. Date of Electronic Publication: 2019 Oct 31.
DOI:	10.1016/j.hpb.2019.10.011
Abstrakt:	Background: Elevated portal pressure in response to major liver resection is associated with impaired liver regeneration and increased postoperative complications. Terlipressin, a splanchnic vasoconstrictor used for treatment of hepatorenal syndrome, was tested for reduction of complications and renal protection after liver resection. Methods: A randomized double-blinded placebo-controlled trial including patients undergoing elective major liver resection was performed. Terlipressin was administered to patients in the intervention group for five days. The primary outcome parameter was the incidence of a clinical composite endpoint of following liver specific complications 6 weeks after surgery: liver failure, ascites, bile leakage, intra-abdominal abscess and operative mortality. Postoperative kidney function was assessed as a secondary endpoint. Results: 150 patients (mean age 63.4 years, 73.3% male) were included. No difference was found in the composite endpoint between the placebo and intervention group (32.8% versus 30.8%, relative risk 1.066, 95%CI 0.643 to 1.769, p = 0.85). Patients receiving terlipressin showed a significant lower decrease in postoperative estimated glomerular filtration rate compared to placebo (two way ANOVA, p = 0.005). Conclusion: Perioperative administration of terlipressin during major liver surgery did not affect a composite endpoint of liver specific complications, but significantly protected from postoperative deterioration of kidney function compared to placebo. CLINICALTRIALS. Gov Identifier: NCT01921985. (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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