Background: Terlipressin, in general, is a vasopressor which acts via V1 receptors. Its infusion elevates mean blood
pressure and can reduce bleeding which has a splanchnic origin. The primary outcome was to assess the impact of
intraoperative terlipressin infusion on portal venous pressure during hepatobiliary surgery; the 2ry outcomes
included effects upon systemic hemodynamics, estimated blood loss, and postoperative renal functions.
Methods: This prospective randomized study involved 50 patients undergoing hepatobiliary surgery who were
randomly and equally allocated into terlipressin group, or a control group. The terlipressin group received an initial
bolus dose of (1 mg over 30 min) followed by a continuous infusion of 2 μg/kg/h throughout the procedure and
gradually weaned over the first four postoperative hours, whereas the control group received the same volumes of
normal saline. The portal venous pressure changes were measured directly through a portal vein angiocatheter.
Results: Portal pressure was significantly reduced over time in the terlipressin group only (from 17.88 ± 7.32 to
15.96 ± 6.55 mmHg, p < .001). Mean arterial blood pressure was significantly higher in the terlipressin group.
Estimated blood loss was significantly higher in the control group than the terlipressin group (1065.7 ± 202 versus
842 ± 145.5 ml; p = 0.004), and the units of packed RBCs transfused were significantly higher in the control group
((0–2) versus (0–4) p = 0.003). There was no significant difference between groups as regards the incidence of acute
kidney injury.
Conclusion: Intraoperative infusion of terlipressin during hepatobiliary surgery was shown to improve
intraoperative portal hemodynamics with subsequent reduction in blood loss.
Trial registration: Clinical trial number and registry URL: Trial registration number: NCT02718599. Name of registry:
ClinicalTrials.gov. URL of registry: https://clinicaltrials.gov/ct2/show/NCT02718599. Date of registration: March 2016.
Date of enrolment of the first participant to the trial: April 2016.
Keywords: Terlipressin, Portal pressure, Hemodynamics, Blood loss