The hemodynamic effects of intravenous paracetamol (acetaminophen) in patients with chronic liver disease undergoing liver transplantation: a pilot study

Abstract Objective We performed a single-center double-blinded, randomized trial to investigate the hemodynamic effects of IV paracetamol in patients with chronic liver disease (CLD) undergoing liver transplantation surgery. Patients with CLD are particularly susceptible to hemodynamic derangements given their low systemic vascular resistance state. Accordingly, hypotension is common in this setting. The hemodynamic effects of IV paracetamol in patients undergoing elective liver transplantation are unknown, therefore we evaluated whether the intraoperative administration of IV paracetamol in patients with chronic liver disease undergoing liver transplantation results in adverse hemodynamic effects. The primary end point was a change in systolic blood pressure 30-min after the preoperative infusion. Results Twenty-four participants undergoing liver transplantation surgery were randomly assigned to receive a single bolus of IV paracetamol (1 g paracetamol + 3.91 g mannitol per 100 mL) (n = 12) or placebo (0.9% Saline 100 mL) (n = 12). All participants completed their study intervention, and there were no breaches or violations of the trial protocol. Baseline characteristics were similar in both groups. There were no significant differences regarding surgical duration, intraoperative use of fluids, and intraoperative noradrenaline use. After the administration of paracetamol there were no significant differences observed in blood pressure or other hemodynamic parameters when compared to placebo.

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Faculty Opinions recommendation of Safety and efficacy of a single bolus administration of recombinant factor VIIa in liver transplantation due to chronic liver disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1048403.500313 ◽

2007 ◽

Author(s):

John Feiner

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Chronic Liver Disease ◽

Recombinant Factor Viia ◽

Factor Viia ◽

Chronic Liver ◽

Bolus Administration ◽

Safety And Efficacy ◽

Single Bolus

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Anaemia in patients with chronic liver disease and its association with morbidity and mortality following liver transplantation

International Journal of Surgery ◽

10.1016/j.ijsu.2018.02.053 ◽

2018 ◽

Vol 53 ◽

pp. 48-52 ◽

Cited By ~ 5

Author(s):

Oliver Collas ◽

Francis P. Robertson ◽

Barry J. Fuller ◽

Brian R. Davidson

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Morbidity And Mortality

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Hepatic encephalopathy

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0320 ◽

2020 ◽

pp. 3080-3089

Author(s):

Paul K. Middleton ◽

Debbie L. Shawcross

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Hepatic Encephalopathy ◽

Chronic Liver Disease ◽

Wide Spectrum ◽

Chronic Liver ◽

Electrolyte Disorders ◽

The West ◽

Optimal Medical Management ◽

Type C

Hepatic encephalopathy (HE) is a significant complication of both acute and chronic liver disease, causing much morbidity and mortality. It is a complex neuropsychological condition, associated with hyperammonaemia and systemic inflammation, with a wide spectrum of symptoms. The West Haven criteria describe grades of severity from 0 (subclinical) and I (changes in awareness, mood, attention, cognition, and sleep pattern) through to IV (coma). It is further classified by the underlying aetiology: type A, due to acute liver failure; type B, secondary to portosystemic shunting; and type C, occurring in chronic liver disease in association with precipitating factors including infections, gastrointestinal bleeding, and electrolyte disorders, particularly hyponatraemia. There is no definitive test or set of diagnostic criteria to establish a diagnosis of HE, which remains primarily a clinical diagnosis of exclusion in patients with a history or clinical evidence of liver disease. Management depends on the type of HE, but for type C (the commonest type) typically includes lactulose and rifaximin. Patients with cirrhosis with ongoing overt HE despite optimal medical management have a dismal outlook and should be considered promptly for liver transplantation.

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Portal Angiogenesis in Chronic Liver Disease Patients Correlates with Portal Pressure and Collateral Formation

Digestive Diseases ◽

10.1159/000500115 ◽

2019 ◽

Vol 37 (6) ◽

pp. 498-508 ◽

Cited By ~ 1

Author(s):

Carolina A. Serrano ◽

Simon C. Ling ◽

Sofia Verdaguer ◽

Miguel León ◽

Nicolás Jarufe ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Hypertension ◽

Liver Disease ◽

Chronic Liver Disease ◽

Venous Pressure ◽

Portal Pressure ◽

Peripheral Circulation ◽

Chronic Liver ◽

Noninvasive Markers ◽

Collateral Formation

Background/Aims: One hallmark of chronic liver disease in patients with portal hypertension is the formation of portal-systemic collaterals in which angiogenesis has a fundamental role. We studied patients with chronic liver disease undergoing liver transplantation to correlate levels of circulating angiogenic factors in portal and peripheral circulation with portal pressure and portal-systemic collaterals. Methods: Sixteen patients who underwent liver transplantation were enrolled. During transplant surgery, we determined portal venous pressure and portal-systemic collateral formation. We determined angiogenics mediator levels in systemic and portal plasma. Peripheral plasma from healthy donors was measured as controls. Results: Vascular endothelial growth factor (VEGF)-R1 and 2, Ang-1 and 2, Tie2, FGF- 1 and 2, CD163, PDGFR-β, PDGFsRα, PDGF-AB and BB, CD163, TGF-β VASH-1 levels were significantly different in the controls in comparison to cases. Significantly decreased portal venous levels of Ang-1, FGF-1, PDGF-AB/BB, and CC were observed in patients with higher portal pressure. Peripheral VEGF, Ang-1, pPDGF-AB, BB, and CC were significantly decreased in patients with more severe collateral formation. While peripheral VEGF-R1 was higher in patients with severe collateral formation. For portal circulation, VEGF, Ang-1, pPDGF-AB, BB, and CC were significantly decreased in patients with more severe collateral formation Conclusions: Angiogenesis factors correlated with portal pressure and collateral formation and different patterns of circulating angiogenesis mediators were found in peripheral and portal blood of patients with chronic liver disease. These results support the importance of angiogenic pathways in cirrhosis and portal hypertension and highlight areas for further study to identify clinically useful noninvasive markers of portal pressure and collateral formation.

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