Impact of Intraoperative Norepinephrine Support on Pediatric Living
Donor Liver Transplantation Outcomes
Abstract
Aim Norepinephrine (NE) is often administered during the perioperative
period of liver transplantation. However, its role and safety profile
have yet to be evaluated in pediatric living donor liver transplantation
(LDLT). The aims of this study was to analyze the effect of
intraoperative NE infusion on recipients’ survival following pediatric
LDLT. Methods A retrospective study of 430 pediatric patients receiving
LDLT between 2014 and 2016 at Renji Hospital was conducted. We evaluated
patient survival among recipients who received intraoperative NE
infusion (NE group, 85 recipients) and those that did not (Non-NE group,
345 recipients). Results The number of children aged over 24 months and
weighing more than 10 kg in NE group was more than that in Non-NE group.
And children in NE group had longer operative time, longer anhepatic
phase time and more fluid infusion. After multivariate regression
analysis and propensity score regression adjusting for confounding
factors to determine the influence of intraoperative NE infusion on
patient survival, the NE group had a 169% more probability of dying.
Although there was no difference in mean arterial pressure changes
relative to the baseline between the two groups, we did observe
increased heart rates in NE group compared with those of the Non-NE
group at anhepatic phase (P=0.025), neohepatic phase (P=0.012) and
operation end phase (P=0.017) of the operation. Conclusion
Intraoperative NE infusion was associated with poor prognosis for
pediatric LDLT recipients. We recommend the application of NE during
pediatric LDLT should be indicated carefully to avoid potentially
hazardous effects.