Portal Pressure Effects of Phlebotomy Combined to Vasopressin Use in Cirrhotic Patients Undergoing Liver Transplantation
Portal Pressure Effects of Phlebotomy Combined to Vasopressin Use in Cirrhotic Patients Undergoing Liver Transplantation
Liver transplantation is the standard treatment for chronic advanced liver disease, whether
 or not associated with a primary liver tumor. The intraoperative bleeding and the need for
 blood transfusion, encountered in this major surgery are associated with increased morbidity
 and mortality. However, this hemorrhagic risk has been drastically reduced in the last 20
 years and liver transplants without the use of blood products are now possible. Indeed,
 improvements in medical and surgical techniques associated with a better understanding of the
 pathophysiology of the cirrhotic patient have enabled this advance. One of the targeted
 therapeutic strategies is the control of portal hypertension. Several treatments have been
 sought, such as the use of splanchnic vasoconstrictors (such as vasopressin) and hypovolemic
 phlebotomy. These techniques reduce portal pressure and seem to reduce intraoperative
 bleeding with, even, a protective effect on kidney function. Their single-use or their
 combination is currently used in certain centers of expertise in liver transplantation.
 However, the hemodynamic effects of the combination of these 2 treatments on portal pressure
 has never been demonstrated. In this study, the effect of vasopressin, combined with a
 hypovolemic phlebotomy, on portal pressure in cirrhotic patients undergoing liver
 transplantation will be evaluated.
METHODS

 Objectives

 The primary objective will be to measure the hemodynamic effects of vasopressin on portal
 pressure in cirrhotic patients who have had a hypovolemic phlebotomy during a liver
 transplant.

 The secondary objectives will be to measure the effects of vasopressin on portal pressure in
 patients who have not had a phlebotomy and to compare this effect between patients who have
 or have not had a hypovolemic phlebotomy.

 The tertiary objective will be to assess the effect of the variation in portal pressure under
 vasopressin, associated or not with a hypovolemic phlebotomy, on hemorrhagic clinical
 outcomes (intraoperative bleeding and blood transfusions).
Inclusion Criteria:

 -  Cirrhotic patients undergoing a liver transplantation

 -  18 years and older

 -  Planned use of vasopressin during the surgery

 Exclusion Criteria:

 -  Fulminant or sub-fulminant hepatitis without underlying chronic liver disease

 -  Anesthetic plan does not include the use of vasopressin (contraindication or not
 relevant according to the anesthesiologist)