Perioperative Variation of Plasma Copeptin and Its Association With Vasopressor Need During Liver Transplantation.

Abstract

Background: Vasopressor usage during liver transplant is related to decreased hepatic flow, graft failure, and mortality. We measured plasma Copeptin levels in liver transplant patients based on vasopressor requirements. We hypothesize that preoperative plasma copeptin measurement helps predict the vasopressor infusion requirement during liver transplantation in preoperative evaluation.

Methods: The plasma Copeptin of 40 patients was measured 5 times: before the operation, 15 minutes before and after reperfusion, and postoperative 12^th and 24^th hours. Patients were categorized into 2 groups based on vasopressor infusion for comparison.

Results: There was a statistically significant rise in median serum Copeptin concentration between the preoperative phase and before reperfusion (11.2 [7.3-20.9] vs 178.5 [121.5-243.0], P < .001), as well as a statistically substantial decline between after reperfusion and postoperative 12^th hours (190.6 [127-276.3] vs 74.7 [42.0-124.9], P < .001). The vasopressor-taking group had significantly higher plasma copeptin at postoperative 12^th hours (96.6 [71.4-191.7] vs 55.0 [31.8-82.5], P = .030) and 24^th (133.7 [72.2-175.5] vs 51.1 [24.8-85.8], P = .037). A tendency above 11.85 pmol/L of plasma Copeptine level was observed between increasing preoperative plasma Copeptin and the odds of vasopressor use.

Conclusion: High preoperative plasma Copeptin levels may be an indicator of vasopressor need during liver transplantation. Further studies with more samples, including a higher range of preoperative plasma Copeptin levels, are required to provide more generalizable findings and to determine thresholds applicable to LT candidates.