Postoperative hemodynamic stabilization with terlipressin: A case of liver transplantation

Year 2025, Volume: 42 Issue: 1, 98 - 100, 28.03.2025

Neslihan Ünal Akdemir , Özkul Yılmaz Çolak , Melda İşevi , Tuğçehan Sezer Akman , Fatma Ulger

Abstract

This report presents the successful management of a patient with acute liver failure on the background of chronic liver disease who underwent liver transplantation. Terlipressin, a vasoactive agent, managed hepatorenal syndrome and acute kidney injury by promoting splanchnic vasoconstriction and intrahepatic vasodilation, improving renal blood flow and hemodynamic stability. The case involves a 41-year-old woman with autoimmune hepatitis and primary biliary cirrhosis who required triple vasoactive therapy postoperatively. Bolus doses of terlipressin reduced the need for other vasopressors, stabilized renal function, and facilitated her recovery. This case underscores the potential of terlipressin as a valuable therapeutic option in the postoperative management of liver transplantation patients with refractory hemodynamic instability. Careful dosing and monitoring are essential to optimize outcomes and minimize risks.

Keywords

Hepatorenal Syndrome, Liver Transplantation, Terlipressin

Ethical Statement

We confirm that no ethical violations were committed in preparing this case report.

Thanks

We would like to extend our heartfelt gratitude to the Liver Transplant Surgery Team, the Anesthesiology and Reanimation Team, and the Organ Transplant Coordination Unit at Ondokuz Mayıs University for their invaluable support and contributions.

References

• 1. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426-1437.
• 2. Sarin SK, Choudhury A. Acute-on-chronic liver failure: terminology, mechanisms and management. Nat Rev Gastroenterol Hepatol. 2016;13(3):131-149.
• 3. Maiwall R, Sarin SK, Moreau R. Acute kidney injury in acute-on-chronic liver failure. Hepatol Int. 2016;10(2):245-257.
• 4. Gifford FJ, Morling JR, Fallowfield JA. Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1. Aliment Pharmacol Ther. 2017;45(5):593-603.
• 5. Wong F. Terlipressin for hepatorenal syndrome. Curr Opin Gastroenterol. 2024;40(2):156-163.
• 6. Jamil K, Pappas SC, Deverakonda KR. In vitro binding and receptor-mediated activity of terlipressin at vasopressin receptors V1 and V2. J Exp Pharmacol. 2017;10:1-7.
• 7. Villanueva C, Planella M, Aracil C, López-Balaguer JM, González B, Miñana J, et al. Hemodynamic effects of terlipressin and high somatostatin dose during acute variceal bleeding in nonresponders to the usual somatostatin dose. Am J Gastroenterol. 2005;100(3):624-630.
• 8. Israelsen M, Krag A, Allegretti AS, Jovani M, Goldin AH, Winter RW, et al. Terlipressin versus other vasoactive drugs for hepatorenal syndrome. Cochrane Database Syst Rev. 2017;9(9):CD011532.
• 9. Zhang L, Tian M, Sun LY, Zhu ZJ. Prophylactic terlipressin infusion for severe postreperfusion syndrome in patients undergoing deceased donor liver transplantation: the TIPS-DDLT randomized controlled trial. Int J Surg. 2023;109(7):1923-193.
• 10. Gifford FJ, Morling JR, Fallowfield JA. Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1. Aliment Pharmacol Ther. 2017;45(5):593-603.
• 11. Weinberg EM, Wong F, Vargas HE, Curry MP, Jamil K, Pappas SC, Sharma P, Reddy KR. Decreased need for RRT in liver transplant recipients after pretransplant treatment of hepatorenal syndrome-type 1 with terlipressin. Liver Transpl. 2024;30(4):347-355.