Effect of Preoperative Beta Blocker Use Postoperative Renal Function in the Patients Undergoing Liver Transplantation
Effect of Preoperative Beta Blocker Use Postoperative Renal Function in the Patients Undergoing Liver Transplantation
This is prospective cohort study of patients classified by the premedication history of
 beta-blocker. The investigators aim to evaluate the hemodynamic effect of beta blocker
 through Swan-Ganz catheter monitoring and arterial pressure waveform analysis during surgery.
 The investigators also plan to observe the long-term effects of beta blocker on acute renal
 failure, allograft failure and mortality.
Since beta blockers have been shown to reduce portal venous pressure in 1980, the
 nonselective beta blocker (NSBB) has been widely used for the last 25 years as the primary
 treatment for portal hypertension. NSBB, such as propranolol and nadolol, has been shown to
 reduce cardiac output through β1 -receptor block and to constrict visceral vessels via
 β2-receptor block, thereby lowering portal venous pressure in patients with chronic liver
 disease. NSBB contributed to reducing complications such as esophageal variceal bleeding,
 ascites, hepatic encephalopathy, and improving survival in patients with cirrhosis. In
 addition, the use of NSBB in patients with ascites has been demonstrated to reduce the
 digestion time of intestinal food and reduce bacterial migration into the abdominal cavity
 and bloodstream.

 On the other hand, recent studies have shown that NSBB use in the patients with advanced
 cirrhosis (accompanied by refractory ascites, spontaneous peritonitis, severe alcoholic
 hepatitis) may increase circulatory failure, acute renal failure, and mortality. When the
 cardiac index was less than 1.5 L / min / m² or the mean blood pressure was less than 80 mmHg
 in advanced cirrhosis with ascites, 1-year survival rate was found to be about 30% lower than
 the control. The use of beta blockers is argued to be avoided in the cirrhotic patients with
 refractory ascites because the mortality rate of these patients is associated with the use of
 beta blockers. These studies have been questioned in terms of reliability of the setting of
 treatment and control groups and correction of disturbance variables.

 The window hypothesis has received attention for the risk-benefit of NSBB. This means that
 the beta blocker may be beneficial or harmful to the cirrhotic patients depending on the
 stage of disease progression. In conclusion, the use of beta-blockers in patients with early
 cirrhosis without moderate to large varix has no effect on prevention of esophageal varices,
 but is associated with depression, tiredness, sexual dysfunction, decreased cardiac output,
 increased risk of heart failure, symptomatic bradycardia, increased airway resistance, and
 bronchospasm. As the cirrhosis progresses, many changes occur in the cardiovascular system.
 The sympathetic nervous system and resin-angiotensin-aldosterone axis are up-regulated to
 compensate for the lack of effective blood volume due to peripheral vascular relaxation and
 hypotension. It is believed that the use of beta-blockers at this time may improve survival
 by reducing esophageal bleeding and bacterial migration. If the liver cirrhosis progresses
 more, the use of beta-blockers may compromise cardiac output, blood pressure, perfusion to
 important organs, thereby increasing the incidence of hepatorenal syndrome and mortality. The
 use of beta-blockers seems to be beneficial between the point of moderate to large varix
 generation to the point of advanced cirrhosis with undesired hemodynamic effect (spontaneous
 ascites, hepatorenal syndrome, spontaneous bacterial peritonitis, sepsis). The research is
 still ongoing and controversial.

 As mentioned earlier, the use of beta blockers in patients with liver disease has been
 actively studied for the last 10 years, but most studies have been done in patients waiting
 for liver transplantation. Research is minimal in patients who actually undergo liver
 transplantation. In addition, studies have shown that beta blockers increase survival in
 patients waiting for liver transplantation by lowering portal venous pressure through beta 1,
 2 -receptor block. But the actual research of preoperative beta blocker on perioperative
 hemodynamics, postoperative complications, and mortality is still lacking.

 This is prospective cohort study of patients classified by the premedication history of
 beta-blocker. The investigators aim to evaluate the hemodynamic effect of beta blocker
 through Swan-Ganz catheter monitoring and arterial pressure waveform analysis during surgery.
 The investigators also plan to observe the long-term effects of beta blocker on acute renal
 failure, allograft failure and mortality.
Inclusion Criteria:

 -  living donor liver transplantation recipients

 Exclusion Criteria:

 -  previous history of acute kidney injury

 -  previous liver transplantation history

 -  Fulminant hepatic failure

 -  history of TIPS, transjugular intrahepatic porto-systemic shunt