الفهرس 
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Abstract
Liver transplantation is currently the treatment of choice for patients with end stage liver disease or liver failure for which no other treatment modality is available. To this day, living-donor liver transplant remains the only possible option for patients with end stage liver disease in Egypt as cadaveric or deceased liver donation has not yet been implemented although legalized since 2010.
Patients should be considered for LT if they have evidence of fulminant hepatic failure, a life-threatening systemic complication of a liver disease or a liver-based metabolic defect or, more commonly, cirrhosis with complications such as hepatic encephalopathy, ascites, hepatocellular carcinoma, hepatorenal syndrome, or bleeding caused by portal hypertension.
Liver transplantation is often associated with hemodynamic instability. Systemic and Splanchnic circulation systems interact closely. Portal hypertension is linked to vasodilatory molecules overproduction resulting in lower central blood volume as well as arterial vasodilatation.
Terlipressin, is a synthetic long-acting vasopressin analogue causes selective splanchnic arteriolar vasoconstriction, thus decreasing splanchnic blood flow and shifting blood from the splanchnic to the systemic circulation resulting in enhanced systemic hemodynamics.
The aim of this study is to assess the effect of intraoperative terlipressin on adult living donor liver transplantation recipients with respect to systemic hemodynamics which will be evaluated by systolic, diastolic blood pressure, heart rate, arterial blood gases (to evaluate global tissue oxygenation and acid-base balance based on lactate concentration and PH), total blood products requirement, and requirements of norepinephrine.
Also to assess the effect of intraoperative terlipressin on hepatic hemodynamics in the form of hepatic arterial resistive index, peak portal vein blood flow velocity, hepatic artery blood flow and portal venous pressure using non invasive method (Doppler ultrasound).
After analyzing the data it was found that as regards systemic hemodynamics terlipressin had proved to be effective in improving systolic and diastolic blood pressure and so elevating SVR in anhepatic phase and post perfusion phase (Neohepatic phase) and so decreasing requirements of Norepinephrine and improving tissue perfusion in the form of decreasing serum lactate level and decreasing base defecit during neohepatic phase, but it had no effect in the current study neither on blood products requirements nor urinary output through operation. Also it decreases heart rate in anhepatic phase and neohepatic phase.
As regards hepatic hemodynamics, peak portal blood flow and portal venous pressure were reduced with terlipressin without effect on HARI or signs of splanchnic hypo perfusion.
Further studies involving more patients is recommended to study the effect on intraoperative terlipressin on hepatic hemodymaics using invasive and non invasive methods