Aprotinin reduces vasoactive medication use during adult liver transplantation

Abstract

Study objective: To determine whether aprotinin use during adult liver transplantation results in an improvement in hemodynamic stability.

Design: Review of data collected during a prospective, randomized, double-blind trial.

Setting: Liver transplantation program in a tertiary referral institution.

Patients: 63 adult patients undergoing orthotopic liver transplantation (OLT).

Interventions: Patients were randomized to receive either aprotinin (1,000,000 KIU loading dose, followed by an infusion of 250,000 KIU/hr) for the duration of the surgery or a placebo infusion (normal saline).

Measurements: Hemodynamic parameters (mean systemic blood pressure, cardiac output, systemic vascular resistance, mean pulmonary artery (PA) pressure, and PA occlusion pressure) were compared at set time points during the procedure. The use of vasoactive medications during and after the reperfusion period was compared.

Main results: There were no significant differences in any of the measured hemodynamic parameters at any time point. Vasoactive infusions were used in 1 of 33 patients in the aprotinin group and in 6 of 30 patients in the control group (p < 0.05). Bolus doses of pressor medications during the recirculation period did not differ between groups.

Conclusion: Aprotinin infusion during adult liver transplantation results in less requirement for vasoactive intervention.