Perioperative Evaluation of Terlipressin Infusion During Living Donor Liver Transplantation on Incidence of Acute Kidney

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).