Norepinephrine Boluses in Liver Transplantation

• Status: Completed
• Trial end date: 2020-08-28
• Target enrollment: 0
• Participant gender: All

Summary

We study the efficacy of Norepinephrine boluses on prevention of postreperfusion syndrome during living donor liver transplantation.

NE and Post-reperfusion:

On portal vein declamping, we will start rapid 500 ml 4% albumin infusion or packed RBCs (according to the anhepatic hemoglobin level 5 min before declamping) through 14 Gauge peripheral venous cannula in all patients.

NE boluses technique; We will inject NE boluses in the C.V.P port of the pulmonary artery catheter with 5 ml saline flushing after each. After reperfusion, we will start bolus noradrenaline 20 µg if mean arterial blood pressure (mABP) decreases by 10 % or more of the basal reading (immediately before portal vein declamping after ensuring withholding of the surgical manipulation). Additional NE boluses will be given as follow;

• If mABP rises to 65 mmHg (lowest target level), we will hold NE boluses.

• If mABP remains constant or begins to rise but did not reach 65 mmHg, we will give 20 µg after 10 seconds from the previous bolus

• If mABP continues to drop, we will add 10 µg to the previous dose after 10 seconds and can be repeated.

• If mABP remains below 65 mmHg more than 1 minute, we will give the scheduled bolus NE with adding 20 µg adrenaline boluses.

• Phase: Phase 1/Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Mansoura University
• Treatments: Norepinephrine

Criteria

Inclusion Criteria:

• All patients subjected to living donor liver transplantation with right lobe liver graft.

Exclusion Criteria:

1. Acute fulminant hepatitis

2. Chronic hypertension

3. Moderate to severe valvular heart disease

4. Chronic kidney disease (CKD) and Hepatorenal syndrome (HRS)

5. Preoperative S.Cr elevation > 1.4 mg/kg or dialysis recently before surgery

6. Long standing diabetes mellitus (> 10 years on insulin)

7. Moderate and sever Porto-pulmonary hypertension

8. Moderate and sever Hepato-pulmonary syndrome (HPS)

9. Contraindications to pulmonary artery catheter insertion

10. Budd Chiari syndrome

11. Re-transplantation

12. Massive blood transfusion (more than 5 units of blood before portal clamping)

13. Graft/weight ratio > 1.4 and < 0.8