Perioperative Evaluation of Terlipressin Infusion During Living Donor Liver Transplantation on Incidence of Acute Kidney (Terli-NGAL)

December 14, 2016 updated by: Hanaa Rashed, National Liver Institute, Egypt
To study the impact of intra and post-operative Terlipressin infusion on the occurrence of acute kidney injury after LDLT To investigate perioperative Neutrophil Gelatinase Associated Lipocalin (NGAL) changes and study the effect of Terlipressin on NGAL blood levels

Study Overview

Detailed Description

The study will be conducted after approval of the local ethics and research committee of anesthesia, ICU and pain management of both Faculty of Medicine and Liver Institute, Menoufia University, Egypt. This study will be conducted in Anesthesia Department, National Liver Institute hospital on patients undergoing liver transplantation. They will be simply randomized with closed envelopes into two groups. Terlipressin group and Control group. A written informed consent will be taken from every patient.

Inclusion criteria: Adult living donor liver transplant recipients with no preoperative renal dysfunction Exclusion criteria: patients with renal insufficiency defined as serum creatinine > 2 mg/dl and GFR <60 ml/min by isotope scanning of the kidney.

Anesthetic Technique:

All patients will be monitored by electrocardiography, noninvasive and invasive arterial blood pressure, pulse oximetry, capnography, fraction inspired oxygen concentration (FiO2). After preoxygenation, general anesthesia will be induced with Propofol 2 mg/kg IV, Fentanyl 2 µg/kg IV and Rocronium 0.9 mg/kg IV followed by endotracheal intubation and maintenance with a mixture of air, oxygen 50% with Desflurane. Mechanical ventilation will be adjusted to maintain end-tidal CO2 between 35-40 mmHg. Central venous line will be inserted for monitoring of central venous pressure (CVP) with ultrasonography guidance.

The esophageal Doppler probe will then be inserted orally and positioned approximately 35-40 cm from the teeth (CardioQTM®, Deltex Medical, Chichester, UK). Normothermia (core temperature > 36°C) will be maintained intraoperatively using forced warming air blanket (Bair Hugger®; Arizant, UK).

After induction of anesthesia patients will be randomly divided into two groups Terlipressin group, Terlipressin (Glypressin®, Rentschler biotechnology Gmbh, Erwin, Germany) will be started by continuous infusion at a dose of 1-4 µg/kg/h till day 4 postoperatively. In the control group, continuous placebo infusion will be started. The Anesthesia team will be kept blind to the contents of the infusion.

Rotetional thromboelastometry [ROTEM] will guide intraoperative blood transfusion protocol as prescribed by the study of Gorlinger K will be followed in both groups. (13) Platelets will be substituted when maximum clot firmness of (MCF EXTEM) <45mm and maximum clot firmness of FIBTEM (MCF FIBTEM) >8mm.

Fresh frozen plasma will be administerd when clot formation time representing extrinsic coagulation pathway (CFT EXTEM) was >240sec. Hematocrite will be kept more than or equal to 25 with packed red blood cells units.

All patients will receive intraoperative methylprednisolone (10 mg/kg). Hemodynamics will be maintained, keeping mean blood pressure above 60 mmHg by fluids and vasoactive drugs.

After surgery, all patients will be transferred to the intensive care unit for controlled mechanical ventilation. The patients will be extubated when hemodynamics are stable, liver graft functions satisfactory, sufficient spontaneous breathing, and core temperature >36°C.

Measured Parameters:

-Evaluation of renal function and injury:

  • Serum Cr levels and BUN will be determined preoperatively and then daily up to 5 days after surgery.
  • The glomerular filtration rate (GFR) or the nearest approximation of GFR will be calculated from the equation of modification of Diet in Renal Disease Study on the basis of obtained serum Cr levels and patient demographics.
  • Urine output
  • Determination of NGAL Blood samples for the determination of NGAL will be drawn at 3 different time points: immediately after the induction of anesthesia, 2 hours after reperfusion, and 24 hours after reperfusion.

Blood samples will be drawn at the predetermined time points and processed within 2 hours after collection. Serum will be collected and subsequently frozen at -80°Celsius until further analysis -Hemodynamic parameters:

• Heart rate, mean arterial blood pressure [MABP], and CVP, cardiac output (COP), stroke volume (SV), corrected flow time (FTc), systemic vascular resistance (SVR) will be recorded after induction of anesthesia, then every hour during the operation.

Other parameters:

  • Anhepatic phase time, warm and cold ischemia time.
  • Graft weight , recipient graft body weight ratio.
  • Fluid, blood product transfusion.
  • Blood glucose level, postoperative complication.
  • ICU stay, length of hospital stay.
  • 30 days mortality The need for postoperative renal replacement therapy.

Study Type

Interventional

Enrollment (Actual)

25

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Menoufiya
      • Shebeen Alkom, Menoufiya, Egypt, 32511
        • National liver Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult living donor liver transplant recipients with no preoperative renal dysfunction

Exclusion Criteria:

  • patients with renal insufficiency defined as serum creatinine > 2 mg/dl and GFR <60 ml/min by isotope scanning of the kidney.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Placebo Comparator: Control group
Experimental: Terlipressin group
Terlipressin group, Terlipressin (Glypressin®, Rentschler biotechnology Gmbh, Erwin, Germany) will be started by continuous infusion at a dose of 1-4 µg/kg/h till day 4 postoperatively
Terlipressin (Glypressin®) will be started by continuous infusion at a dose of 1-4 µg/kg/h till day 4 postoperatively
Other Names:
  • Glypressin

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Development of acute kidney injury
Time Frame: 5 days postoperatuvely
it is elevation of serum creatinine >1.5 mg/dL
5 days postoperatuvely

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Hanaa S Rashed, MSc, National Liver Institute, Egypt

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2013

Primary Completion (Actual)

December 1, 2016

Study Completion (Actual)

December 1, 2016

Study Registration Dates

First Submitted

November 10, 2013

First Submitted That Met QC Criteria

February 8, 2014

First Posted (Estimate)

February 11, 2014

Study Record Updates

Last Update Posted (Estimate)

December 15, 2016

Last Update Submitted That Met QC Criteria

December 14, 2016

Last Verified

December 1, 2016

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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