ReviewBMC anesthesiology2025
The use of terlipressin to treat refractory hypotension during allograft kidney transplantation: a report of 4 cases and literature review.
Review in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntraoperative hypotension is a recognized risk factor for delayed graft function (DGF) after kidney transplantation and may compromise both short- and long-term allograft outcomes. However, the controversy persists regarding the optimal vasopressors and inotropes for maintaining stable blood pressures intraoperatively and achieving good allograft outcome after kidney transplantation. Terlipressin has demonstrated the potential in stabilizing hemodynamics and enhancing renal blood flow in patients with hepatorenal syndrome and sepsis. Additionally, terlipressin may effectively correct efractory hypotension in those receiving renin-angiotensin system inhibitors (RASi). However, it is unclear whether terlipressin is suitable for optimizing perioperative blood pressures and is favorable for postoperative graft function in patients with kidney transplantation. CASES PRESENTATION: We reported 4 cases of patients with end-stage renal disease undergoing allograft kidney transplantation who developed intraoperative hypotension unresponsive to dopamine or fluid resuscitation. Intravenous terlipressin rapidly stabilized hemodynamics and maintained adequate mean artery pressure throughout surgery, with a reduced consumption of other vasopressors. All patients demonstrated satisfactory early graft function within the first postoperative week, with improved glomerular filtration rate, and normal serum potassium concentration and urine output. Furthermore, renal function was stable at one-year follow-up.
conclusionsTerlipressin may represent an effective and renal-protective alternative for intraoperative blood pressure maintenance during kidney transplantation. Further controlled studies are warranted to validate the potentials of terlipressin for maintaining perioperative blood pressure and optimizing postoperative allograft function in patients undergoing kidney transplantation.
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